CLINICAL OUTCOMES OF PRIMARY VALVE ABLATION VERSUS URINARY DIVERSION IN INFANTS WITH POSTERIOR URETHRAL VALVES: A PROSPECTIVE COHORT STUDY
DOI:
https://doi.org/10.69723/njms.04.04.0662Keywords:
posterior urethral valve, primary valve ablation, urinary diversion, chronic kidney disease, pediatric urologyAbstract
Background: Posterior urethral valves (PUV) are a congenital condition affecting the male urinary tract and characterised by membranous folds in the posterior urethra, presenting as the most common cause of lower urinary tract obstruction in paediatric patients. Primary valve Ablation (PVA) and urinary diversion (UD) are the treatment choices depending on the patient's condition and the surgeon's understanding.
Objective: The current study aimed to evaluate the clinical outcomes of PVA versus UD in male children under the age of one year.
Methods: The prospective cohort study included 110 patients, with 55 in each of the PVA and UD intervention groups. After three months of follow-up the outcomes, voiding dysfunction, urine dribbling, straining, slow stream, recurrent Urinary Tract Infections (UTIs), predictors of chronic kidney disease (CKD), as albumin excretion and Glomerular filtration rate (GFR), were evaluated.
Results: Mean age was 6.89±3.07 months, albumin excretion 24.50±10.13 mg/day, and GFR 76.46±18.34/ml/min/1.73m2 in participants. Duration of surgery in PVA was 25.40±5.47 minutes and 129.94±18.44 minutes in UD. Recurrent UTIs were reported in 19.1%, urine dribbling in 38.2%, urine straining in 19.1%, and a slow stream of urine in 28.2% participants. No significant difference was reported in urine dribbling P=0.578, urine slow stream P=0.289, and urine straining P=0.089. Recurrent UTIs, P=0.04, were significant with OR=2.22 in the UD group as compared to PVA. Albumin excretion P=0.776 and GFR P=0.487 were insignificant. Age of the child had a significant negative association with Albumin excretion r= -0.288, P=0.002 and a moderate negative association with GFR r=-0.346, P<0.001.
Conclusion: There was no significant difference in clinical outcomes of PVA versus UD at three-month follow-up, in terms of CKD and voiding dysfunction, except recurrent UTIs reported two times higher in the UD group. The study limitation was short followup, a single centre investigation and lower sample size.
References
1. Bingham G, Leslie SW, Rentea RM. Posterior Urethral Valves. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 [cited 2025 June 30]. Available from: http://www.ncbi.nlm.nih.gov/books/NBK560881/
2. Ekarat P, Attawettayanon W, Limratchapong C, Sophark P, Vachvanichsanong P. Posterior urethral valve in thai boys. BMC Pediatr. 2023 Sept 7;23(1):445.
3. Bomlaski. Posterior Urethral Valves: Practice Essentials, Pathophysiology, Etiology. 2024 Mar 22 [cited 2025 July 1]; Available from: https://emedicine.medscape.com/article/1016086-overview#a6
4. Khan K, Din I, Khan MY. MANAGEMENT OF INFANTS AND CHILDREN WITH POSTERIOR URETHRAL VALVES: EARLY OUTCOME OF ENDOSCOPIC VALVE FULGURATION IN A TERTIARY CARE HOSPITAL IN PESHAWAR. J Saidu Med Coll Swat [Internet]. 2017 [cited 2025 July 1];7(1). Available from: http://www.jsmc.pk/index.php/jsmc/article/view/56
5. El-Ghoneimi A, Harper L, Pierucci UM, Blanc T, Rosenblatt J, Sananes N, et al. Management of patients with posterior urethral valves “from the fetus to adolescence”: French national diagnostic and care protocol (NDCP). Orphanet J Rare Dis. 2025 May 12;20(1):225.
6. Assefa HG, Getachew H, Tadesse A, Kiflu W, Temesgen F, Dejene B, et al. Outcome of PUV Patients Following Ablation in a Tertiary Teaching Hospital in Addis Ababa, Ethiopia. Res Rep Urol. 2021;13:639–45.
7. Hofmann A, Haider M, Cox A, Vauth F, Rösch WH. Is Vesicostomy Still a Contemporary Method of Managing Posterior Urethral Valves? Child Basel Switz. 2022 Jan 21;9(2):138.
8. Khondker A, Chan JY, Malik S, Kim JK, Chua ME, Henderson B, et al. Primary ablation versus urinary diversion in posterior urethral valve: Systematic review and meta-analysis. J Pediatr Urol. 2023 Aug;19(4):408–17.
9. Salih EM, Abdrabuh AM, Okasha AH, Galal H. Temporary vesicostomy in pediatrics: What are the potential predictors of functional and morphological improvement of the upper urinary tract? J Pediatr Urol. 2021 Dec;17(6):834.e1-834.e9.
10. Yadav P, Rickard M, Weaver J, Chua M, Kim JK, Khondker A, et al. Pre-versus postnatal presentation of posterior urethral valves: a multi-institutional experience. BJU Int. 2022 Sept;130(3):350–6.
11. Matsell DG, Yu S, Morrison SJ. Antenatal Determinants of Long-Term Kidney Outcome in Boys with Posterior Urethral Valves. Fetal Diagn Ther. 2016;39(3):214–21.
12. Kwong JC, Khondker A, Kim JK, Chua M, Keefe DT, Dos Santos J, et al. Posterior Urethral Valves Outcomes Prediction (PUVOP): a machine learning tool to predict clinically relevant outcomes in boys with posterior urethral valves. Pediatr Nephrol Berl Ger. 2022 May;37(5):1067–74.
13. Rickard M, Dos Santos J, Keunen J, Lorenzo AJ. Prenatal hydronephrosis: Bridging pre- and postnatal management. Prenat Diagn. 2022 Aug;42(9):1081–93.
14. Wu CQ, Lovin JM, Patil D, Smith EA. Role of progressive urethral dilation and primary valve ablation in the long-term renal outcomes of small, preterm infants with posterior urethral valve. J Pediatr Urol. 2022 Dec;18(6):802.e1-802.e6.
15. Alsaywid BS, Mohammed AF, Jbril SM, Bahashwan M, Mukharesh L, Al Khashan M. Renal outcome among children with posterior urethral valve: When to worry? Urol Ann. 2021;13(1):30–5.
16. Nawaz G, Hussain I, Muhammad S, Jamil MI, Rehman AU, Iqbal N, et al. Justification For Re-Look Cystoscopy After Posterior Urethral Valve Fulguration. J Ayub Med Coll Abbottabad JAMC. 2017;29(1):30–2.
17. Hosseini SMV, Zarenezhad M, Kamali M, Gholamzadeh S, Sabet B, Alipour F. Comparison of early neonatal valve ablation with vesicostomy in patient with posterior urethral valve. Afr J Paediatr Surg AJPS. 2015;12(4):270–2.
18. Amirzargar H, Shahab E, Ghahestani S, Hekmati P, Arshadi H. Risk Factors Associated with Chronic Kidney Disease in Infants With Posterior Urethral Valve: A Single Center Study of 110 Patients Managed By Valve Ablation And Bladder Neck Incision. Urol J. 2020 Sept 23;18(4):429–33.
19. Kim SJ, Jung J, Lee C, Park S, Song SH, Won HS, et al. Long-term outcomes of kidney and bladder function in patients with a posterior urethral valve. Medicine (Baltimore). 2018 June;97(23):e11033.
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