Antenatal Diagnosis of Posterior Urethral Valves

Dinneen, M; Dhillon, H.K.; Ward, Humphry; Duffy, P.G.; Ransley, P. G.

doi:10.1111/j.1464-410x.1993.tb00734.x

Cited by 98 publications

(40 citation statements)

References 14 publications

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“…There are, however, no studies showing that the long-term outcome among boys with antenatally detected PUVs is better than among those cases detected postnatally after developing symptoms. Furthermore, in one study the outcome of patients with antenatal detection was significantly worse than in those detected postnatally [7]. We found no difference in the long-term outcome between antenatally and postnatally detected patients.…”

Section: Discussioncontrasting

confidence: 55%

“…With time, however, the benefit of antenatal diagnosis has been questioned [8,9]. In only a few studies has the long-term renal outcome among boys with antenatally detected PUVs been compared with that of postnatally diagnosed, usually symptomatic patients [7,8,9,10].…”

Section: Introductionmentioning

confidence: 98%

“…With the development of early diagnostic modalities and different treatment methods, and the widespread use of antenatal ultrasonography (US) in particular, the diagnosis of severe urinary tract abnormalities such as PUVs has advanced considerably [4]. Early on, antenatal US was enthusiastically proposed to be of particular benefit in cases of malformation with potential mortality, such as PUVs [5,6,7]. With time, however, the benefit of antenatal diagnosis has been questioned [8,9].…”

Section: Introductionmentioning

confidence: 99%

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Prognostic factors of posterior urethral valves and the role of antenatal detection

2004

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The aim of the study was to investigate the significance of different prognostic factors and long-term renal outcome in boys with posterior urethral valves (PUVs) detected either antenatally or during infancy. A total of 46 cases of PUVs, 23 antenatal and 23 postnatal, were followed prospectively from 1983 to 2003. The mean follow-up time was 12.5 years. The impact of vesicoureteral reflux (VUR), urinary tract infections (UTIs), urinary continence, and renal parenchymal damage on patient outcome was evaluated. Long-term renal outcome was defined as favorable if renal function was either normal or moderately impaired (glomerular filtration rate > or = 60 ml/min per 1.73 m(2)) and poor if the patient had either chronic renal failure or end-stage renal disease. The outcome was poor in 14 (30%) of the 46 boys and was associated with a significantly higher nadir serum creatinine concentration (mean 157 micromol/l) during the 1st year of life ( P<0.001), with bilateral VUR ( P<0.05) and breakthrough UTIs ( P<0.05). In our patients, age at achieving urinary continence, and the presence of renal parenchymal damage did not have a statistically significant association with long-term renal outcome. The long-term outcome among boys with antenatally detected PUVs did not differ from that among those cases detected postnatally after developing symptoms ( P=0.25).

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Section: Discussioncontrasting

confidence: 55%

Section: Introductionmentioning

confidence: 98%

Section: Introductionmentioning

confidence: 99%

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Prognostic factors of posterior urethral valves and the role of antenatal detection

2004

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“…Improvements in the management of neonates and infants with sepsis and renal failure have reduced the mortality of this group [22]. The issue whether prenatal detection and early treatment improve prognosis of infravesical obstruction is controversial [23][24][25]. However, an accurate identification of fetal bladder outlet obstruction has irrefutable merits.…”

Section: Discussionmentioning

confidence: 99%

Predictive Factors of Fetal Urethral Obstruction: A Multivariate Analysis

Oliveira

Diniz²,

Cabral

et al. 2000

Fetal Diagn Ther

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Objective: The purpose of this study was to identify predictive factors of fetal urethral obstruction. Methods: One hundred and forty-eight children with fetal hydronephrosis were admitted, submitted to a systematic protocol and prospectively followed. Possible predictive factors of urethral obstruction associated with fetal echography and clinical findings on admission were studied. The analysis was conducted in two steps. In a univariate analysis, variables associated with urethral obstruction were identified by the χ² test or by Fisher’s exact test. Then, the variables that were significantly associated with urethral obstruction were included in a multiple logistic regression analysis. Results: After final adjustment by multiple logistic regression analysis, only two variables were identified as independent predictors of fetal urethral obstruction: oligohydramnios (odds ratio, OR = 5, 95% confidence interval, CI, = 1.3–15, p = 0.01) and megacystis (OR = 9, 95% CI = 2.0–40, p = 0.004). The sensitivity and specificity of the combination of both variables were 60 and 98.5%, respectively. Conclusions: The presence of oligohydramnios and megacystis on prenatal ultrasound is highly predictive of fetal urethral obstruction.

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“…3,4 Characteristic ultrasound features are significant oligohydramnios and a dilated, tense (and variably thick-walled) bladder, with a dilated proximal urethra ('key-hole sign'). Secondary ultrasound features of bilateral hydronephrosis with renal parenchymal abnormalities of 'echogenicity' and micro/macrocystic change are associated with renal dysplasia.…”

Section: Introductionmentioning

confidence: 99%

Congenital lower urinary tract obstruction: a population‐based epidemiological study

Malin

Tonks

Morris

et al. 2012

BJOG

154

121

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Objective To determine the prevalence and outcome of lower urinary tract obstruction (LUTO), including the sensitivity of antenatal diagnosis.Design A retrospective population-based study. Setting Regional population-based congenital anomalies register (WMCAR).Population Fetuses affected by LUTO delivered between 1995 and 2007 to women resident in the West Midlands.Methods Cases were selected from the WMCAR using codes and keyword terms from the International Classification of Diseases, tenth revision (ICD10). Diagnoses were validated using additional data sets from Regional Fetal Medicine, Perinatal Pathology and Paediatric services.Main outcome measures Rates of prevalence, prenatal diagnosis and mortality, with trends.Results There were 284 LUTO cases in 851 419 births during the study period, representing a total prevalence of 3.34 (2.95-3.72) per 10 000 births, and this prevalence did not change significantly over time. The prevalence of LUTO was significantly higher in Black and minority ethnic groups when compared with white Europeans (OR 2.38; 95% CI 1.87-3.03), and are associated with area-based deprivation measures (P < 0.01). Of all LUTO cases, 221 (77.8%) were isolated, and the remainder were associated with other structural or chromosomal anomalies. The most common subtype was posterior urethral valves (PUVs; n = 179, 63%). In total there were 211 (74.3%) cases of isolated, nonfemale, singleton fetuses that fitted the referral criteria for in utero vesico-amniotic shunting, giving a prevalence of 2.48 (2.14-2.81) per 10 000 live births. Within this group, the prenatal diagnosis rate was 46.9% (99/211).Conclusion This is the largest population-based study of LUTO that has been performed to date, and provides accurate estimates for prevalence. The low prevalence and relatively low rate of antenatal detection limit the number of cases amenable to prenatal surgical intervention.

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Antenatal Diagnosis of Posterior Urethral Valves

Cited by 98 publications

References 14 publications

Prognostic factors of posterior urethral valves and the role of antenatal detection

Prognostic factors of posterior urethral valves and the role of antenatal detection

Predictive Factors of Fetal Urethral Obstruction: A Multivariate Analysis

Congenital lower urinary tract obstruction: a population‐based epidemiological study

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