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

Concurrent valve ablation and bladder neck incision is suggested as an effective and safe treatment ap-proach in posterior urethral valve children with prominent bladder neck. We evaluated chronic kidney disease risk factors in these children.

We retrospectively reviewed medical records of children with posterior urethral valve and included those younger than 18 years old who underwent valve ablation and bladder neck incision at our insti-tution. We recorded patient demographics, presenting symp-toms, laboratory and radiographic data. Our primary outcome was chronic kidney disease de-fined as stage 3 chronic kidney disease or higher. Renal outcome risk factors such as preoperative vesicoureteral reflux and serum creatinine, age at diagnosis, adjuvant urinary diversion were ana-lyzed.

A total of 110 patients met our inclusion criteria. The median age at diagnosis was 10.4 months (range 14 days to 12 years). Prenatal diagnosis in 72.7% was the most common presenta-tion. Mean follow-up duration was 3 years and 12 (10.9%) patients progressed to chronic kidney disease. Preoperative serum creatinine greater than 1 mg/dL was the only factor associated with progression to chronic kidney disease.

In our group of children with posterior urethral valve ablation and bladder neck in-cision, initial creatinine value of greater than 1 mg/dL is more probably associated with renal im-pairment while; vesicoureteral reflux, age at diagnosis, presenting symptoms, and adjuvant uri-nary diversion were not significant prognostic factors. Further randomized controlled evaluations are required to analyze the effects of concurrent valve ablation and bladder neck incision on renal outcome.