Abstract Book - 26th ESPU Congress, Joint Meeting with ICCS + SPU + AAP/SOU + AAPU + SFU

S27-10

(P)

POSTERIOR URETHRAL VALVES: IS VESICOURETERAL REFLUX A RISK FACTOR

FOR PROGRESSION TO RENAL FAILURE?

Aylin BILGUTAY

, David ROTH

, Edmond GONZALES

, Nicolette JANZEN

, Wei ZHANG

, Chester KOH

, Patricio

GARGOLLO

and Abhishek SETH

1) Baylor College of Medicine, Urology, Houston, USA - 2) Texas Children's Hospital, Urology, Houston, USA - 3) Texas

Children's Hospital, Statistics, Houston, USA

PURPOSE

To assess outcomes of patients with posterior urethral valves (PUVs).

MATERIAL AND METHODS

We conducted a retrospective analysis of patients presenting to our institution for management of PUVs from 2006-

2014. Univariate and multivariate analysis was performed to determine risk factors for endpoints of chronic kidney

disease (CKD), end-stage renal disease (ESRD), and need for multiple surgeries.

RESULTS

Of 104 patients identified, 42.3% (44/104) were diagnosed prenatally, and 31.8% (14/44) of those underwent prenatal

intervention. Postnatally, 90.4% underwent transurethral resection of PUVs (TUR-PUVs) as the initial operation.

Vesicostomy in 4.8% was the next most common index surgery. At last follow-up, 20.2% CKD of at least stage IIIA, and

8.6% had progressed to ESRD. Antenatal diagnosis, prematurity, abnormal initial RUS, and elevated creatinine on

presentation and at nadir were significantly associated with progression to CKD and ESRD on univariate analysis. Nadir

creatinine was the only independent predictor of final renal function on multivariate analysis. Pre- and postoperative

VUR and recurrent UTIs were associated with the need for multiple surgical interventions, but not with poor renal

outcomes.

CONCLUSIONS

The majority of patients with PUVs (56.7%) required a single surgery and maintained renal function with CKD II or

better (79.8%) up to 2 years after initial operative intervention. While multiple factors were associated with poor renal

outcomes, nadir creatinine was the only independent predictor. VUR and recurrent UTIs were associated with need for

more than one operation, but were not associated with poor renal outcomes. Longer follow-up is necessary to identify

patients at risk for delayed progression to CKD or ESRD.