Evaluation of prognostic factors in posterior urethral valve.

Vaithiyalingam, M A (2011) Evaluation of prognostic factors in posterior urethral valve. Masters thesis, Coimbatore Medical College, Coimbatore.

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Abstract

INTRODUCTION : Posterior urethral valve represents the most common cause of congenital obstructive uropathy leading to childhood renal failure. The incidence of posterior urethral valve is approximately 1:5000 to 1:8000 infant males. Challenges faced by children with posterior urethral valve are multiple. Obstruction by valve is the process which involves the entire urinary system. Appropriate clinical suspicion remains the key to diagnosis which is confirmed by standard imaging techniques. The risk of renal compromise and ultimate renal failure is a potential problem for each patient. The outcome may be altered by appropriate intervention, but in most cases the renal development in utero determines the need for eventual dialysis or transplantation. The prognosis for children with urethral valves is improving and current management is gradually rewriting the historical data. In most modern large series neonatal deaths make upto only 2% to 3% of the series. Early (prenatal) recognition, control of infection, appropriate and selective surgery recognition of harmful urodynamic abnormalities, modern nephrologic management and eventual dialysis and transplantation all combine to increase survival now to an extent unheard of in the past. In the past, the treatment of posterior urethral valve was based primarily on the mechanism of obstruction and its relief. The current treatment of this condition is based upon our evolving knowledge of the consequences of bladder outlet obstruction. So, the quality of life in these patients, are very much improving in the recent days. AIMS : To analyze the various described prognostic factors, in our antenatally diagnosed patients. To determine the prognostic factors that predict the outcome of posterior urethral valve patients postnatally. To identify the significant of the each individual factor in the long term outcome. MATERIALS AND METHODS : Study Type : Retrospective and prospective study. Study period : January 2004 to December 2009. Study centre : Coimbatore Medical College and Hospital, Coimbatore. METHODOLOGY : In our study, we registered 52 cases of posterior urethral valves out of which 7 cases are antenatally diagnosed, 24 cases were in the new born period, 13 cases were between 1 to 12 months of age group, 8 cases were between 1 to 4 years of age group. The initial diagnosis or suspicion of posterior urethral valve based on prenatal ultrasonagraphy, UTI, or others (dehydration, electrolyte changes, palpable bladder, etc.) The patient’s initial evaluation included renal function, urine culture, urine analysis upper and lower urinary tract ultrasonagraphy and MCUG. Among the 52 patients, 43 patients were treated by primary cystoscopic valve ablation and the remaining cases underwent urinary diversion either vesicostomy (6 cases) or cutaneous ureterostomy. All the above patients were evaluated regularly throughout their follow-up and accessing the renal function, urine culture and urine analysis; upper and lower urinary tract ultrasonagraphy, MCUG and DMSA scan. The results were analyzed. CONCLUSION : Early age group (<1 month) at initial presentation is a single most prognostic indicator in our observation. Serum creatinine level at the time of diagnosis, 12 months after valve ablation and at the time of last followup is the main factor that indicates the outcome of the disease. The treatment modalities either primary valve ablation or diversion procedures such as vesicostomy or cutaneous ureterostomy does not affect the outcome of disease process. The prognosis of our antenatally detected PUV patients were dismal Absence of corticomedullary differentiation and altered cortical echos in ultrasonography predict the poor prognostic outcome. Presence of vesicoureteric reflux does not have any impact in the long term outcome. Presence of pressure pop of does not have any significance in our observation. Presence of one or more renal scars in DMSA scan is a definitive predictor for future renal impairment. Only 34% of our patients had good quality of life without renal insufficiency in the 5 year follow-up.

Item Type: Thesis (Masters)
Uncontrolled Keywords: posterior urethral valve ; prognostic factors ; Evaluation.
Subjects: MEDICAL > Paediatric Surgery
Depositing User: Kambaraman B
Date Deposited: 31 Jul 2017 04:39
Last Modified: 31 Jul 2017 05:07
URI: http://repository-tnmgrmu.ac.in/id/eprint/2369

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