A. Nischal Prasad Reddy1
OBJECTIVES: The most common congenital anomaly is Posterior Urethral valve (PUV) and has as incidence of 1 in 8000 male births. It is the most common obstructive cause of end stage renal disease in children. Vesicoureteric reflux, recurrent UTI, voiding dysfunction and late onset renal failure are the long term major problems in these children. There are few long term outcome studies of children with PUV from India. These studies mainly concentrate on the surgical aspects. The study is aimed to assess the long term impact of PUV on renal function and the growth of these children.
METHODS: The study was conducted at AJ hospital, Mangalore between July 2010-June 2011. Thirty children, with posterior urethral valve, five years or more post-surgery were included in the study. The details of children were obtained from records regarding age, presenting symptoms serum creatinine, presence of or absence of vesicoureteric reflux. Outcomes measured were stunting, renal failure (GFR, tubular functions) and bladder functions. Results were analysed.
RESULTS: Thirty children were analysed. The age at presentation varied from antenatal detection to six years. About 46.6% of patients presented between 0-1 month, 36.6% between one month to one year, 16.8% between one to six years. The median age at presentation was three months. Primary surgery done in the neonatal period in 33% children. Of the 28 children who had antenatal ultrasound, 20 had normal USS and eight had antenatally detected hydronephrosis (28.6%). Five out of eight had associated oligohydramnios. All these five children had GFR <90 m/m/1.73m2 at follow up.
CONCLUSION: Poor bladder function was seen in one-third of patients. Interventions as and when needed on follow-up are important in the management of all children with posterior urethral valve. Comprehensive care should be the rule by a team comprising paediatrician, pediatric surgeon and pediatric nephrologists.
