N Berte1, I Vrillon2, O Larmure3, V Gomola3, C Ayav4, C Mazeaud3, J L Lemelle3. 1. Chirurgie viscérale infantile, hôpital Brabois Enfants, CHU de Nancy, rue du Morvan, 54511 Vandœuvre-lès-Nancy cedex, France. Electronic address: n.berte@chru-nancy.fr. 2. Néphrologie et dialyse pédiatrique, hôpital Brabois Enfants, CHU de Nancy, rue du Morvan, 54511 Vandœuvre-lès-Nancy cedex, France. 3. Chirurgie viscérale infantile, hôpital Brabois Enfants, CHU de Nancy, rue du Morvan, 54511 Vandœuvre-lès-Nancy cedex, France. 4. CIC-EC, centre d'investigation clinique, épidémiologie clinique, hôpitaux de Brabois, rue du Morvan, 54511 Vandœuvre-lès-Nancy cedex, France.
Abstract
INTRODUCTION: Congenital Lower Urinary Tract Obstructions (LUTO) is a heterogeneous group of diseases in which urine elimination is obstructed at the level of bladder neck or urethra. The aim of the study is to evaluate the long-term renal outcome of patients suffering of congenital LUTO. PATIENTS AND METHOD: We retrospectively reviewed patients with congenital LUTO. All patients had at least 1 year follow-up. Data on surgery, renal imaging and Schwartz estimate creatinine clearance were collected. Incidence of Chronic Renal Disease (CRD) is presented with Kaplan-Meier method. RESULTS: 40 patients were included, 23 patients with Posterior Urethral Valve (PUVs) and 17 patients with other aetiologies: anterior urethral valve (2), urethral atresia (2), urethral stenosis (2), cloacal malformations (2), obstructive ureterocele (1), bladder trigone malformation (1) and neonatal bladder-sphincter dysfunction without neurological abnormalities (7). Incidence of CRD at age 10 years was 37% in congenital LUTO, 42% in PUVs and 30% in other aetiologies, and was significantly higher in PUVs (P=0.032). Renal prognosis was significantly worsened by discover of retentional bladder wall changes in initial cystoscopy, and by loss of parenchymal differentiation or cortical microcysts in first ultrasonography. The use of urinary diversion was significantly higher in LUTO of other aetiologies. CONCLUSION: A high incidence of CRD is observed in patients with congenital LUTO, significantly higher in patients with PUV. LUTO of other aetiologies require step by step surgical management and higher use of urinary diversion. Precise initial evaluation in cystoscopy and ultrasonography is required and participate to evaluate future renal outcome. LEVEL OF INCIDENCE: 4.
INTRODUCTION:Congenital Lower Urinary Tract Obstructions (LUTO) is a heterogeneous group of diseases in which urine elimination is obstructed at the level of bladder neck or urethra. The aim of the study is to evaluate the long-term renal outcome of patients suffering of congenital LUTO. PATIENTS AND METHOD: We retrospectively reviewed patients with congenital LUTO. All patients had at least 1 year follow-up. Data on surgery, renal imaging and Schwartz estimate creatinine clearance were collected. Incidence of Chronic Renal Disease (CRD) is presented with Kaplan-Meier method. RESULTS: 40 patients were included, 23 patients with Posterior Urethral Valve (PUVs) and 17 patients with other aetiologies: anterior urethral valve (2), urethral atresia (2), urethral stenosis (2), cloacal malformations (2), obstructive ureterocele (1), bladder trigone malformation (1) and neonatal bladder-sphincter dysfunction without neurological abnormalities (7). Incidence of CRD at age 10 years was 37% in congenital LUTO, 42% in PUVs and 30% in other aetiologies, and was significantly higher in PUVs (P=0.032). Renal prognosis was significantly worsened by discover of retentional bladder wall changes in initial cystoscopy, and by loss of parenchymal differentiation or cortical microcysts in first ultrasonography. The use of urinary diversion was significantly higher in LUTO of other aetiologies. CONCLUSION: A high incidence of CRD is observed in patients with congenital LUTO, significantly higher in patients with PUV. LUTO of other aetiologies require step by step surgical management and higher use of urinary diversion. Precise initial evaluation in cystoscopy and ultrasonography is required and participate to evaluate future renal outcome. LEVEL OF INCIDENCE: 4.
Keywords:
Anomalies congénitales du rein et des voies urinaires (CAKUT); Congenital anomalies of the kidney and the urinary tract (CAKUT); Lower urinary tract obstruction (LUTO); Néphrologie pédiatrique; Obstruction sous-vésicale congénitale (LUTO); Paediatric nephrology; Paediatric urology; Posterior urethral valves; Urologie pédiatrique; Valve de l’urètre postérieur
Authors: Hugo López-Briones; Rosa Villalobos-Gómez; Eréndira Chávez-González; Miguel Martínez-Rodríguez; Antonio Helue-Mena; Alma Gámez-Varela; Rogelio Cruz-Martinez Journal: AJOG Glob Rep Date: 2022-01-13