ESPU Meeting on Friday 19, April 2024, 15:05 - 16:15
15:05 - 15:08
S19-1 (OP)
Saidul KABIR 1, Rusab SARMUN 2, Elias RAMÍREZ-VELÁZQUEZ 3, Anil TAKVANI 4, Muhammad E. H. CHOWDHURY 5 and Tariq Osman ABBAS 6
1) University of Dhaka, Department of Electrical and Electronic Engineering, Dhaka, BANGLADESH - 2) University of Dhaka,, 2Department of Electrical and Electronic Engineering,, Dhaka, BANGLADESH - 3) Hospital Infantil de México Federico Gómez, Pediatric Urology Department, Mexico, MEXICO - 4) Takvani Kidney Hospital,, Takvani Kidney Hospital, Gujarat, INDIA - 5) Qatar University,, Department of Electrical Engineering, Doha, QATAR - 6) Sidra Medicine, Urology, Doha, QATAR
PURPOSE
Posterior Urethral Valves (PUV) is a major cause of bladder outlet obstruction in boys and is associated with kidney disease. Traditional diagnosis relies on subjective interpretations of imaging techniques, introducing variability. The study proposes an AI-based approach for automated PUV detection from voiding cystourethrography images, aiming to reduce subjectivity and improve accuracy.
MATERIAL AND METHODS
The urethra region was segmented from 183 VCUG images, and a variety of image preprocessing techniques were used to enhance visibility. Urethral ratios were computed by identifying anterior and posterior regions through morphological operations. Data augmentation enriched the training dataset, and multiple segmentation networks were trained. Combining different encoders with UNet and UNet++ architectures was done. A mask combination and postprocessing step was also used to improve segmentation performance.
RESULTS
Dice score coefficient (DSC) is a metric readily used to evaluate segmentation performance. DenseNet201 combined with Unet achieved the best DSC of 66.15, out of all encoder decoder combinations. The optimal cutoff urethral ratio for PUV detection was determined at 2.01. Masks with ratios above and below the cutoff were classified as "PUV" and "Non PUV" respectively, achieving an overall accuracy of 81.52%.
CONCLUSIONS
This study is the first of its kind to enhance Posterior Urethral Valve (PUV) detection in VCUG images through automated segmentation and processing, reducing subjectivity and workload for clinicians. The approach lays the foundation for future research to fully automate VCUG assessment and PUV diagnosis and management. Improved interrater agreement speeds up detection and minimizes diagnostic discrepancies.
15:08 - 15:11
S19-2 (OP)
Franziska Juliane RICHTER 1, Hayley GOOD 2, Michael E. CHUA 1, Jin K. KIM 1, Joana DOS SANTOS 1, Armando J. LORENZO 1, Tim VAN MIEGHEM 3, Shiri SHINAR 3 and Mandy RICKARD 1
1) The Hospital for Sick Children (SickKids), Division of Urology, Toronto, CANADA - 2) University of Toronto, Faculty of Medicine, Toronto, CANADA - 3) Mount Sinai Hospital, Division of Maternal and Fetal Medicine, Department of Obstetrics and Gynecology, Toronto, CANADA
PURPOSE
In absence of “classic” ultrasound features, some cases of lower urinary tract obstruction(LUTO) are misclassified.Herein,we explore the ultrasound features associated with a higher likelihood of a missed prenatal LUTO diagnosis,report postnatal outcomes and validate a previously described risk stratification tool fordetection of prenatal LUTO.
MATERIAL AND METHODS
A chart review of pregnancies with prenatally-suspected or postnatally-confirmed LUTO-cases was conducted at a high-risk fetal center and tertiary pediatric center between 2009 to 2022.We excluded fetuses without prenatal ultrasounds,postnatal follow-up or unknown postnatal diagnosis.Ultrasound features of false negative and true positive diagnosed LUTO fetuses were compared to detect predictors associated with a higher risk of a missed diagnosis.The Toronto Nomogram was utilized to predict the probability of LUTO in atypical cases based on initial ultrasound features.
RESULTS
Out of 130 postnatally confirmed LUTO cases,19 were misclassified prenatally as hydronephrosis(HN),hydroureteronephrosis(HUN),duplication anomalies,MCDK,or renal agenesis(14.6%).Missed LUTO patients had a later gestational age at initial prenatal consult(28 weeks of gestation;IQR17,38;p=0.0018) and at postnatal management(21.0 days;IQR5,1143;p=0.0199).The risk of a false negative diagnosis was higher in fetuses with unilateral HUN(p=0.0130 and p=0.0148)and decreased for fetuses with megacystis or the keyhole sign(p=0.0022 and p<0.0001).The Toronto nomogram classified 90.7%(117/129) of fetuses correctly as LUTO(probability>65%) and misclassified(<30% probability) the remaining 9.3%(12/129).Postnatally,atypical LUTO fetuses required less diversions(p=0.02) and no renal replacement therapies.
| False negative(n=19) | True positive(n=111) | p-value | |
| Postnatal deaths(%) | 11.1(2/19) | 5.4(6/111) | 0.3308 |
| IUFD/Stillbirths(%) | 0.0(0/19) | 5.4(6/111) | 0.5917 |
| Termination of pregnancy(%) | 5.6(1/18) | 36.9(41/111) | 0.0067* |
| Age initial management(days) | 21.0(IQR 5,1143) | 9.0(IQR2,313) | 0.0199* |
| Dialysis/transplantation | 0.0(0/15) | 11.9(12/111) | 0.3575 |
CONCLUSIONS
Prenatal detection of atypical LUTO cases remains challenging due to heterogeneous ultrasound findings. These findings call attention to the need for heightened suspicion in cases that lack classic features.The utilization of AI-tools could not detect all atypical prenatal LUTO cases,however,it contributed to higher detection rates.Further work is required to refine our algorithm to improve prenatal LUTO detection.
15:11 - 15:14
S19-3 (OP)
Davide MENEGHESSO 1, Nicola BERTAZZA PARTIGIANI 1, Rachele SPAGNOL 1, Alessandra Rosalba BRAZZALE 1, Alessandro MORLACCO 2 and Enrico VIDAL 1
1) Azienda Ospedale-Università di Padova, Pediatric Nephrology, Padova, ITALY - 2) Urology Clinic, Urolgy, Padova, ITALY
PURPOSE
Posterior urethral valves (PUVs) represent the most severe paediatric obstructive uropathy, responsible for chronic renal failure in up to 65% of cases and progression to end-stage kidney disease (ESKD) in about 8%-21% of patients. Postnatal nadir creatinine seems to accurately predict long-term renal prognosis, but there is no definitive evidence to support this finding. We performed a systematic review with meta-analysis to analyse the predictive value of nadir creatinine on long-term renal function in infants with PUVs.
MATERIAL AND METHODS
We conducted this systematic review according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. PubMed and Cochrane Library were systematically searched for studies published from January 2008 to June 2022. All the articles were checked independently by two reviewers in two steps.
RESULTS
A total of 24 articles were screened, and 13 were included for data extraction. Data from 1,731 patients with PUVs were analysed, with a mean follow-up of 5.5 years; of these, on average, 37.9% developed chronic kidney disease (CKD) and 13.6% developed ESKD. All the articles evaluated nadir creatinine as a predictor of CKD, most using a level of 1 mg/dL, with statistical significance at the 5% level. The relative risk of developing CKD in patients with creatinine values higher than the nadir cutoff considered was 7.69 (95% CI: 2.35-25.17, I 2 = 92.20%, p < 0.001).
CONCLUSIONS
Nadir creatinine is the best prognostic factor for long-term renal function in patients affected by PUV. A value above the cutoff of 1 mg/dL should be considered a significant predictor for the risk of CKD and ESKD. Further studies are needed to define different nadir creatinine cutoffs for better stratification of the different CKD stages and for the development of reliable scores, which include the association of several variables.
15:14 - 15:17
S19-4 (OP)
Jin Kyu (Justin) KIM 1, Priyank YADAV 2, Daniel KEEFE 3, Chris BITCON 3, Michael CHUA 1, Mohd Sualeh ANSARI 2, Adree KHONDKER 1, Juliane RICHTER 1, Joana DOS SANTOS 1, Armando LORENZO 1 and Mandy RICKARD 1
1) The Hospital for Sick Children (SickKids), Urology, Toronto, CANADA - 2) Sanjay Gandhi Postgraduate Institute of Medical Sciences, Urology, Lucknow, INDIA - 3) Dalhousie Medical School, Urology, Halifax, CANADA
PURPOSE
We aim to validate a posterior urethral valves (PUV) scoring system using clinical variables at presentation to identify risk categories to individualize follow up and upper/lower urinary tract optimization.
MATERIAL AND METHODS
Patients who presented with posterior urethral valves diagnosed prior to June 2022 from institution 1 (Canada) were included. The outcomes were eGFR at 1- and 5-year endpoints. We performed univariate analysis to determine potential predictors of CKD stage ≥3 at 5-years (defined as p≤0.1). Based on the ß value of the significant variables in backward logistic regression, a scoring system was developed. We performed external validation on a cohort of from institution 2 (India) and institution 3 (Canada).
RESULTS
From institution 1, 120 patients had 1-year eGFR data and 117 patients had 5-year eGFR data. Based on this data, a new scoring system (PURK Score) was developed (Table). The PURK score risk-stratified patients at risk of CKD stage ≥ 3 at 1-year and 5-years of follow up. For institution 1, the model had excellent AUROC of 0.907 for 1-year and 0.873 for 5-year CKD≥3 prediction. External validation of institution 2 showed AUROC of 0.932 and 0.960 for 1-year (n=11) and 5-year CKD≥3 (n=9) predictions. External validation of institution 3 showed AUROC of 0.885 and 0.786 for 1-year (n=17) and 5-year CKD≥3 (n=8) predictions. On combined analysis of all three institutions, AUROC was 0.900 and 0.887 for 1- and 5-year predictions (p<0.0001).
| Clinical variable at presentation | Points |
| Baseline Cr >150umol/L | +2 |
| Failure to thrive |
+2 |
| High grade VUR on US | +1 |
| Renal dysplasia on US | +1 |
| Total score | /6 |
CONCLUSIONS
PURK score, internally validated/developed from a large quaternary referral centre and externally validated from two institutions, provides accurate stratification of patients who are at risk of CKD stage ≥3. Further multi-institutional evaluation is underway for routine use in clinical practice.
15:30 - 15:33
S19-5 (OP)
Silvia PECORELLI 1, Mathilde GLENISSON 2, Matthieu PEYCELON 3, Etienne SUPLY 4, Marc-David LECLAIR 5, Nicolas KALFA 6, Pauline CLERMIDI 7, Alexis ARNAUD 8, Alice FAURE 9, Quentin BALLOUHEY 10, Nadia BOUDAOUD 11, Yann CHAUSSY 12, Thomas BLANC 13 and Luke HARPER 14
1) CHU Pellegrin-enfants, Pediatric urology, Bordeaux, FRANCE - 2) Necker enfant-malades, Pediatric surgery, Paris, FRANCE - 3) Hopital robert debre, Pediatric surgery, Paris, FRANCE - 4) CHU de La Reunion, Saint-Denis, FRANCE - 5) CHU Nantes, Pediatric surgery, Nantes, FRANCE - 6) CHU Montpellier, Pediatric surgery, Montpellier, FRANCE - 7) Hopital Trousseau, Pediatric surgery, Paris, FRANCE - 8) CHU rennes, Pediatric surgery, Rennes, FRANCE - 9) CHU Marseille, Pediatric surgery, Marseille, FRANCE - 10) CHU Limoges, Pediatric surgery, Limoges, FRANCE - 11) CHU Reims, Pediatric surgery, Reims, FRANCE - 12) CHU Besançon, Pediatric surgery, Besançon, FRANCE - 13) Necker enfants-malade, Pediatric surgery, Paris, FRANCE - 14) CHU Pellegrin-Enfants, Pediatric Surgery, Bordeaux, FRANCE
PURPOSE
It has been suggested that patients with Posterior urethral valves (PUV) an a solitary functioning kidney have poorer long-term renal function than those with 2 functioning kidneys. We compared long-term eGFR of PUV patients with and without solitary kidneys.
MATERIAL AND METHODS
We used the CIRCUP database, which included only patients with prenatally suspected, postnatally confirmed PUV, born between 2012 and 2017. Standard follow-up included the diagnostic and control cystograms as well as an early DMSA scan performed between 1 and 6 months of age. We retrospectively compared long-term eGFR (>5 years of age) between those with or without findings of solitary functioning renal-unit (<10% differential function of a renal unit). We also looked at whether these solitary units had reflux or not.
eGFR was calculated using the updated Schwartz formula. Comparison between groups was done using the Mann-Whitney U-test. The study respects our national ethics regulations.
RESULTS
48 PUV patients were included, of which 9 had a solitary kidney. There were no differences in baseline characteristics between both groups, nor in timing of DMSA scan or latest follow-up.
DMSA was performed at a median 60 days of life (IQR: 39-72). Median nadir creatinine was 31 µmol/l (IQR: 22-56). The latest creatinine was recovered at a median 77 months of age (IQR: 64-91).
There was no statistical difference in eGFR between both groups. eGFR was respectively 92 (IQR: 58.5-107.5) and 104 (IQR: 64.5-120) for those with 2 or 1 functioning kidney.
2/9 patients had reflux in the solitary kidney on the initial cystogram and 0/9 on the control cystogram.
CONCLUSIONS
In our series we found no difference in long-term eGFR between boys with PUV and one or two functioning kidney. Relative function on DMSA alone is insufficient to determine decreased renal reserve.
15:33 - 15:36
S19-6 (OP)
Cal H ROBINSON 1, Mandy RICKARD 2, Nivethika JEYAKUMAR 3, Graham SMITH 3, Eric MCARTHUR 3, Joana DOS SANTOS 2, Rahul CHANCHLANI 4 and Armando J LORENZO 2
1) The Hospital for Sick Children, Paediatric Nephrology, Toronto, CANADA - 2) The Hospital for Sick Children, Urology, Toronto, CANADA - 3) London Health Sciences Centre, Lawson Health Research Institute, London, CANADA - 4) McMaster University, Pediatric Nephrology, Hamilton, CANADA
PURPOSE
To determine the risk of major adverse kidney events (MAKE) among PUV patients.
MATERIAL AND METHODS
Population-based retrospective cohort study of all males (0-2-years) diagnosed with PUV between 1991-2021 in Ontario, Canada, identified by diagnostic codes in province-wide administrative health databases. Control cohorts were: 1) male general population and 2) male pyeloplasty patients (both 0-2-years, without PUV). The primary outcome was time-to-modified MAKE (death, chronic kidney replacement therapy (KRT; dialysis or kidney transplant), or de novo chronic kidney disease (CKD)). We censored for death, provincial emigration, or Mar 2022.
RESULTS
We included 727 PUV, 855 pyeloplasty, and 1,013,052 general pediatric controls with a follow-up time of 16.6 years (IQR 8.6-24.5). Age at PUV diagnosis was 40 days(IQR 10-196). Throughout follow-up, 32.3% PUV patients developed MAKE vs. 0.8%of general controls. The aHR for MAKE among PUV patients was 36.6(95%CI 31.6-42.4,p<0.001) vs. general controls. The risks of CKD, KRT, hypertension, and AKI were all higher among PUV patients(Table).
| Outcome | PUV patients n=727 n(%) |
Pyeloplasty patients n=855 n(%) |
General pediatric controls n=1,013,052 n(%) |
Adjusted HR(95% CI) (PUV vs. general controls) |
| Major adverse kidney event (MAKE) | 235 (32.3) | 50 (5.8) | 8198 (0.8) | 36.6 ( 31.6-42.4) |
| All-cause mortality | 17 (2.3) | Not reported (NR) for privacy due to small cell size | 4355 (0.4) | 2.9 (1.7-4.8) |
| Kidney replacement therapy (dialysis or transplant) | 61 (8.4) | 6 (0.7) | 155 (<0.01) | 130.7 (78.3-218.2) |
| Chronic kidney disease | 198 (27.2) | 44 (5.1) | 4017 (0.4) | 82.0 (70.8-94.9) |
| Hypertension | 133 (18.3) | 48 (5.6) | 29445 (2.9) | 5.7 (4.7-6.8) |
| Acute kidney injury | 145 (19.9) | 32 (3.7) | 4513 (0.4) | 27.9 (22.8-34.2) |
CONCLUSIONS
PUV patients are at increased long-term risks of CKD, KRT, hypertension, and AKI. This justifies greater kidney function and BP surveillance among children and adults with a PUV history
15:36 - 15:39
S19-7 (OP)
Leene VERMEULEN 1, Eskinder SOLOMON 1, Joanna CLOTHIER 2, Caroline BOOTH 3 and Massimo GARRIBOLI 1
1) Evelina London Children's Hospital, Paediatric Urology, London, UNITED KINGDOM - 2) Evelina London Children's Hospital, Paediatric Nephro-urology and bladder, London, UNITED KINGDOM - 3) Evelina London Children's Hospital, Paediatric Nephrology, London, UNITED KINGDOM
PURPOSE
Posterior urethral valves are a congenital bladder outlet obstruction affecting boys, causing elevated pressures in the urinary system, resulting in impaired bladder and kidney function.
Glomerular filtration rate (GFR), used to monitor the trajectory of the renal function, can be measured through invasive tests or estimated base upon serum creatinine and body surface. Measured GFR is more accurate but, also, a more invasive test.
The aim of the study is to assess if the estimated GFR could provide as accurate values as the more invasive measured GFR in boys with posterior urethral valves through their childhood.
MATERIAL AND METHODS
We retrospectively collected demographic and iohexol GFR, serum creatinine and height at 5, 10 and 15 years of age (both performed as per internal protocol). The estimated GRF was calculated by our laboratory validated formula: (height (in cm) x 31) / creatinine. A one-sample T-test was used to assess if mean difference between eGFR and GFR at 5, 10 and 15 years were statistically significant.
RESULTS
A total number of 134 patients’ data were reviewed.
The mean difference (-/+ SD) between eGFR and GFR at 5, 10 and 15 years were -5.99 (18.2), -11.79 (17.2) and -21.06 (16.79) mL/min/1.73m2. These differences were all statically significant (p<0.001).
Neither the Ethnicity nor the time of initial resection seemed to influence the results
CONCLUSIONS
eGFR seems to significantly underestimates GFR in boys with PUV, regardless of their ethnicity. The magnitude of this underestimation increases with age, and at 15 years of age, the average difference is 21.06 mL/min/1.73m2
15:39 - 15:42
S19-8 (OP)
Ahmed ELKASHEF, Ahmed ABDELHALIM, Mohamed S. DAWABA and Ashraf T. HAFEZ
Urology and Nephrology Center, Mansoura University, Egypt, Department of Urology, Mansoura, EGYPT
PURPOSE
To evaluate the effect of overnight bladder drainage using catheter (OBD) on upper urinary tracts and bladders of boys post posterior urethral valve (PUV) ablation.
MATERIAL AND METHODS
In a randomized controlled trial, boys who had persistent hydronephrosis (HN) at least one year after PUV ablation were included. Those who underwent urinary diversion, had infravesical obstruction or refused to participate were excluded. Patients were randomly allocated into OBD (catheter placement in bladder for 8-12 h every night) or no intervention. Timed voiding every 3 h, anticholinergics drugs and antibiotic prophylaxis were offered for both groups. After 12 months of starting treatment, patients were evaluated for compliance to OBD, dayime continence (>3 h dry), febrile urinary tract infections (UTIs), renal function evaluation by serum creatinine (SCr) and dimercaptosuccinic acid (DMSA) scan, improvement in HN, vesicoureteral reflux (VUR) and bladder morphology assessed by renal & bladder ultrasound and voiding cystourethrogram.
RESULTS
A total of 99 patients; 47 patients underwent OBD and 52 patients had no intervention, were included between August 2021 and September 2022 followed by 12 months of follow up. Compliance to OBD was reported in 78.72% of patients. Daytime dryness was more significantly noted in the OBD patients (63.8% vs. 44.2%, p=0.04). No significant difference was found between both groups regarding febrile UTIs or renal function affection estimated by SCr and DMSA scan. There was significant improvement in HN and VUR resolution in OBD group. Bladder capacity and outline were also significantly better in OBD group. However, bladder wall thickness and post-void urine residual showed no significant difference between both groups.
CONCLUSIONS
OBD might improve daytime continence, HN, VUR and abnormal bladder morphology that persist after PUV ablation. Yet, compliance to OBD remains a matter of concern.
15:55 - 15:58
S19-9 (OP)
Mandy RICKARD, Armando J LORENZO, Juliane RICHTER, Jin Kyu KIM, Michael CHUA and Joana DOS SANTOS
The Hospital for Sick Children, Urology, Toronto, CANADA
PURPOSE
To explore the impact of PUV on quality of life of families and compare them to healthy controls published in the literature.
MATERIAL AND METHODS
From December 2022-Oct 2023 we distributed the family impact module(FIM) of the PedsQL Inventory, to parents of patients with PUV. The FIM measures the impact of chronic illness on the parent and family as a whole. The maximum score is 100, with higher scores reflecting a lower illness impact. We conducted subgroup analyses to determine family impact based on age, initial surgical intervention, catheterizations (CIC) and CKD
RESULTS
A total of 100 families completed the questionnaire. The mean age of the child with PUV was 7+/-5 years. The overall FIM score was 74+/-19, the impact on parent was 77+/-21 and the family impact 80+/-21. Scores were significantly lower for families with children <2y (63+/-28 vs. 78+/-16; p<0.01) and while not significant, family scores were lower for children on CIC (74+/-23 vs. 83+/-19; p=0.07). The reported FIM score for a community sample was 74+/-14, which was not different from our PUV cohort (p=0.19).
| Total | Parent | Family | |||||||
| Yes | No | p | Yes | No | p | Yes | No | p | |
| CIC (n=26) | 71+/-21 | 77+/-19 | 0.26 | 76+/-22 | 78+/-20 | 0.85 | 74+/-23 | 83+/-19 | 0.06 |
| UTIs (n=42) | 71+/-21 | 80+/-17 | 0.08 | 74+/-22 | 80+/-19 | 0.24 | 76+/-22 | 85+/-17 | 0.08 |
| Urinary Diversion (n=34) | 71+/-21 | 77+/-19 | 0.22 | 74+/-23 | 79+/-19 | 0.31 | 76+/-20 | 82+/-20 | 0.25 |
| CKD (>3) (n=18) | 72+/-16 | 76+/-20 | 0.56 | 74+/-18 | 78+/-21 | 0.53 | 77+/-17 | 80+/-21 | 0.56 |
| Age63+/-2878+/-16<0.0169+/-2680+/-170.0272+/-2783+/-170.03 | |||||||||
CONCLUSIONS
The impact of PUV diagnosis appears to impact families of children less than 2years of age; and, while not significant, those on CIC report lower scores compared those who are not. These data may support additional mental health and social work support for these families.
15:58 - 16:01
S19-10 (OP)
Pramod REDDY, Andrew STRINE, William Robert DEFOOR, Michael DAUGHERTY, Nicole CLICK, Marion SCHULTE, Eugene MINEVICH and Brian VANDERBRINK
Cincinnati Children's, Division of Pediatric Urology, Cincinnati, USA
PURPOSE
Social determinants of health (SODH) influence clinical outcomes and account for variation in outcomes for patients with posterior urethral valves (PUV). The patient's family plays a pivotal role in maintaining optimal care for a child with PUV. We have studied the family as a SODH in the outcome of patients with PUV.
MATERIAL AND METHODS
An IRB approved prospective study was performed on Pts with PUV treated between 2018 and 2023. We administered the family management measure questionnaire (FaMM), after obtaining consent. The patients were divided into three cohorts, PUV Pts with native kidneys and voiding (Group 1), PUV Pts with native kidneys that catheterized (CIC) or were diverted (Group 2) and PUV Pts that had been transplanted (Group 3). The data was statistically analyzed for significance with linear regression and two tailed t-Test.
RESULTS
A total of 79 families were enrolled, (n = 25 Group 1), (n = 35 Group 2) and (n = 19 Group 3). The impact on daily life domain scores were significantly different for all groups (p<0.001) with group 3 having the most impact. There was significant differences on the family's life difficulty score between all three groups (p<0.001) with group 1 being the least difficult to care for. There was no difference in the family's perception of their ability to manage their child's condition, but they did report a significantly higher effort score for Pts that required CIC (p<0.001).
CONCLUSIONS
Family stress and burden of care impose adverse impact on the health of Pts with PUV. FaMM scores permit real-time identification of vulnerable families and ‘at risk' PUV patients. This enables implementation of interventions that include referrals to Social Worker and Psychologists. Commitment to family centered care will positively impact the long-term outcome of PUV Pts.
16:01 - 16:04
S19-11 (OP)
Kouame AGBARA 1, Arthur LAURIOT DIT PREVOST 2, Hortense ALLIOT 3, Amane-Allah LACHKAR 1, Annabel PAYE-JAOUEN 1, Rémi BESSON 2, Marc-David LECLAIR 4, Alaa EL GHONEIMI 1, Sébastien FARAJ 4 and Matthieu PEYCELON 5
1) Department of Pediatric Surgery and Urology, University hospital Robert-Debré, Université Paris Cité, National reference center for rare urinary tract malformations (MARVU), Paris, FRANCE - 2) Department of Pediatric Surgery and Urology, CHU Lille, Univ Lille, Lille, FRANCE - 3) Department of Pediatric Surgery and Urology, Hôpital Femme Mère Enfant, Groupement Hospitalier Est, Hospices Civils de Lyon, Nantes, FRANCE - 4) Department of Pediatric Surgery and Urology, Hôpital Mère-Enfant, CHU Nantes, National reference center for rare urinary tract malformations (MARVU), Université de Nantes, Nantes, FRANCE - 5) Department of Pediatric Surgery and Urology, University hospital Robert-Debré, Université Paris Cité, National reference center for rare urinary tract malformations (MARVU), Paediatric Urology, Paris, FRANCE
PURPOSE
Due to the low incidence of anterior urethral valves (AUV), little is known about management and prognosis. We aim to evaluate management and long-term outcomes after AUV endoscopic ablation.
MATERIAL AND METHODS
Children born with AUV were retrospectively identified in three institutions (2000-2023). Diagnosis was confirmed by urethrocystoscopy. Parameters included: prenatal data, imaging, age at diagnosis, pre- and postoperative creatinine. We compared patients with AUV (A) and those with AUV and PUV (B). Endpoint: CKD. Statistics: descriptive, comparative
RESULTS
19 patients (39.7 (38-41) GW, 3378g (2859-3640) BW) were included with 6 (32%) having concomitant PUV. Eleven (58%) had a prenatal suspicion (7/13 (54%) vs. 4/6 (66%), p>0.20), all presenting with bilateral ureterohydronephrosis. At late presentation, symptoms included poor urinary stream (N=12 (63%)) and retention (N=4 (21%)).
Preoperative imaging found an enlarged bladder (N=11 (58%)), bilateral ureterohydronephrosis (N=9 (47%)), diverticular bladder (N=9 (47%)), urethral diverticulum (N=6 (32%)), and vesicoureteral reflux (N=6) (bilateral N=4). Diagnosis and valves ablation was performed at a median (IQR) age of 6 months (0.2-60) (neonatal period (N=8/19)) (7 vs. 4.5, p>0.2).
Median (IQR) pre and postoperative creatinine was 0.89 (0.7-1.6) (A, 0.84 vs. B, 1.84, p=0.02) (over the maximal range in 8/19 cases) and 0.57 (0.4-0.9) mg/dL (A, 0.54 vs. B, 1.11, p=0.09) respectively and decreased significantly after section (p=0.01). After a follow-up of 4 years (2-8), four children reported recurrent UTIs. 68% (13/19) had no evidence of CKD (92% vs. 17%, p=0.003) and 16% (3/19) had CKD II. CKD>2 was only reported in case of PUV association (11% (2/19) III, 5% (1/19) IV). No patient required dialysis or transplantation.
CONCLUSIONS
The severity of AUV, defined by the CKD status, seems to be associated with the concomitant identification of PUV.