Protective Factors in Posterior Urethral Valves

Rittenberg, Michael H.; Hulbert, William C.; Snyder, Howard M.; Duckett, John W.

doi:10.1016/s0022-5347(17)41908-2

Cited by 152 publications

(66 citation statements)

References 9 publications

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“…Primary valve ablation can be achieved in nearly all infants when the diagnosis is made. Those syndrome may be represented by the six patients studied by the Goteborg group in the 20-year-old category, who who have severely damaged kidneys from in utero pressure and have no 'pop-off' mechanism [32] are not likely had a mean bladder capacity of 1000 mL.…”

Section: Discussionmentioning

confidence: 99%

Are ‘valve bladders’ congenital or iatrogenic?

Duckett

1997

British Journal of Urology

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Section: Discussionmentioning

confidence: 99%

Are ‘valve bladders’ congenital or iatrogenic?

Duckett

1997

British Journal of Urology

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“…In the opinion of Adzick et al, 5 however, accumulation into a localized urinoma often provided less adequate decompression and therefore, had a variable effect on renal preservation. On the other hand, Rittenberg et al 4 reported well-preserved renal function in three boys with localized urinomas. Our patients had urinomas in addition to VURD, and the beneficial effect of either could not be determined separately.…”

Section: Discussionmentioning

confidence: 96%

“…2 Urinoma formation may be seen in 3%-17% of neonates with PUV. 3,4 Extravasation presumably results from increased pressure within the obstructed fetal urinary tract, with the rupture of the urinary collecting system, usually at a calyceal fornix. There may be subsequent drainage of the urinoma into the peritoneal cavity, resulting in ascites.…”

Section: Discussionmentioning

confidence: 99%

Protective Factors in Posterior Urethral Valves in Saudi Children

1998

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Posterior urethral valves are the most common cause of bladder obstruction in boys. Clinical presentation may vary, depending upon the degree of obstruction and its sequelae. Pathological changes range from relatively normal upper tracts or a small amount of dilatation to a massive dilatation associated with severe infection or sepsis, azotemia and/or renal dysplasia. In our population they constitute about 17% of chronic renal failure in children. 1The development of renal insufficiency in patients with posterior urethral valves may be attributed to the high pressure generated by urethral obstruction transmitted to the upper tracts in utero. In this review, four cases of posterior urethral valves are described, in which we identified certain protective factors which provided a "pop-off" mechanism that resulted in preservation of intact renal and bladder function. Patients and Methods Case 1This infant was born with bilateral abdominal masses and mild respiratory distress. Antenatal ultrasound showed bilateral hydronephrosis and oligohydramnios. The initial serum creatinine was 200 μmol/L. Ultrasonogram showed bilateral hydronephrosis. A large collection of fluid was seen around the superior pole of the right kidney, measuring 4.4 x 3.1 cm. A similarly large collection was seen around the left kidney. A micturating cystourethrogram (MCUG) showed multiple small bladder diverticulae, a long dilated posterior urethra and a right Grade V vesicoureteric reflux (VUR). A DMSA scan showed 6% function in the right kidney and 94% in the left kidney. The baby underwent cystourethroscopy, vesicostomy and drainage of both perinephric urinomas. The serum creatinine reached 75 μmol/L. At the age of two years the vesicostomy was closed and the valve fulgurated. Cystometry showed a normal bladder capacity. Subsequently he underwent a right nephroureterectomy. At his last follow-up at the age of three years, his serum creatinine was 40 μmol/L. Case 2A 45-day-old infant was referred to us with failure to gain weight from birth and repeated vomiting of one week's duration. The abdomen was distended, with well-defined masses palpable in both loin regions. The initial serum creatinine was 190 μmol/L. A sonogram showed hydronephrotic kidneys with hyperechoic parenchyma. A well-defined urinoma was seen on the anteriomedial aspect of the right kidney (2.6 x 1.1 cm). A cystogram showed multiple diverticulae of varying size, a right Grade IV VUR and a dilated posterior urethra. A DMSA scan showed 7% function in the right kidney and 93% in the left kidney. Cystoscopy showed a Type III posterior urethral valve (PUV). A vesicostomy and drainage of the urinoma by a perinephric drain were performed. On the 10th day after admission, the infant's serum creatinine dropped to 54 μmol/L. A repeat ultrasound showed that the urinoma had regressed in size. The vesicostomy was closed and the valve fulgurated. Cystometry showed normal findings for the age. Ultimately, a right nephroureterectomy was performed. At his last follow up at the age of two year...

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“…Urinary extravasation acting as a "pop-off" mechanism could reduce renal dysplasia and protect renal function. [12] However, this protective mechanism was questioned in recent studies, and it was proposed that the renal functional outcome can also be affected by the underlying pathology and level of obstruction (e.g., a PUV or a UPJ obstruction). [8,13] The functional prognosis of the involved kidney with a UPJ obstruction and an antenatal urinoma is limited, as reported in the literature.…”

Section: Discussionmentioning

confidence: 99%

“…The postnatal function of kidneys with urinomas and PUV has been previously reported to be between 20% and 71%. [6][7][8][9][10][11][12][13][14][15][16] In 1990, Fernbach et al [1] described 5 cases with PUV, in which renal function was preserved in the presence of a urinoma. However, later studies have not identified any protective effect for urinomas in PUV patients.…”

Section: Discussionmentioning

confidence: 99%

Fetal urinoma and prenatal hydronephrosis: how is renal function affected?

Oktar

Salabaş

Kalelioğlu

et al. 2013

Turkish Journal of Urology

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Objective: In our study, the functional prognosis of kidneys with prenatal urinomas were investigated. Material and methods:Between 2006 and 2010, fetal urinomas were detected in 19 fetuses using prenatal ultrasonography (US), and the medical records were reviewed retrospectively. Of the 19 cases, the follow-up data were available for 10 fetuses. The gestational age at diagnosis, prognosis of urinomas, clinical course and renal functions were recorded. Postnatal renal functions were assessed with renal scintigraphy.Results: Unilateral urinomas and increased parenchyma echogenicity in the ipsilateral kidney were detected in all of the fetuses. Of the 10 fetuses with follow-up data, the option of termination was offered in 6 cases of anhydramnios, including 3 cases with signs of infravesical obstruction (a possible posterior urethral valve (PUV) and poor prognostic factors and 3 cases with unilateral hydronephrosis and increased echogenicity in the contralateral kidney. Only one family agreed the termination. The other 5 fetuses died during the early postnatal period. The average postnatal follow-up period in the 4 surviving fetuses was 22.5 months (8-38 months). One patient with a PUV underwent ablation surgery during the early postnatal period. In the postnatal period, none of the 4 kidneys that were ipsilateral to the urinoma were functional on scintigraphic evaluation. The urinomas disappeared in 3 cases. Nephrectomy was performed in one case due to recurrent urinary tract infections. Conclusion:In our study, no function was detected in the ipsilateral kidney of surviving patients with urinomas. Upper urinary tract dilatation accompanied by a urinoma is a poor prognostic factor for renal function.

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Protective Factors in Posterior Urethral Valves

Cited by 152 publications

References 9 publications

Are ‘valve bladders’ congenital or iatrogenic?

Are ‘valve bladders’ congenital or iatrogenic?

Protective Factors in Posterior Urethral Valves in Saudi Children

Fetal urinoma and prenatal hydronephrosis: how is renal function affected?

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