Outcome of Prenatally Diagnosed Posterior Urethral Valve Patients - Experience from a Low Income Country

Mahfuzul Kabir, Musarrat Naz, Md Abdullah Al Farooq, Tanvir Kabir Chowdhury, Md Zonaid Chowdhury, Tahmina Banu

Abstract

Purpose: To evaluate the outcome of prenatally diagnosed posterior urethral valve  (PUV) patients in our setup where fetal interventions are not available.

Methods: This prospective study included 24 PUV patients (July 2007 to December 2012), who  were diagnosed prenatally but had no prenatal interventions and delivered in our center.  Within 24 hours after birth, all of them had urinary ultrasonography (USG). Voiding  cystourethrography (VCUG) and renogram were done in the second week and  cystoscopy with valve ablation during the same admission period. Patients were  followed up regularly after cystoscopic fulguration. Clinical features, treatment, and  outcomes were analyzed.

Results: Predominant clinical features were renal failure  and urinary ascites. Eleven patients (45.8%) had bilateral vesicoureteric reflux  (VUR) of different grades. Eight patients (33.3%) had decreased renal cortical  thickness (<10 mm). All patients underwent cystoscopic fulguration except three  (expired before fulguration). Four patients (16.6%) needed cutaneous vesicostomy  along with fulguration. Follow up period ranged from 3 months to 6 years. At last  follow-up, 9 (37.5%) boys had renal failure; 7 patients (29%) had normal renal  parameters with good urinary stream. Mortality was 7 (29%) including 3 who died  before fulguration.

Conclusion: Prenatally detected PUV children seem to have  both morphologically and functionally compromised urinary system with poor  outcome.

DOI: http://dx.doi.org/10.11593/bje.2013.0103.0022

Bangladesh Journal of Endosurgery Vol.1(3) September 2013: 20-23

Keywords

posterior urethral valve; prenatal diagnosis; renal failure; low income country

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