POSTERIOR URETHRAL VALVES - DOES PRENATAL-DIAGNOSIS INFLUENCE PROGNOSIS

Forty-eight boys with posterior urethral valves were reviewed to asses s the impact on prognosis of prenatal ultrasonography, which had been the method of diagnosis in 17 of them; the remaining 31 presented post natally. Renal function before treatment was mildly to moderately impa ired in 59% of those presenting prenatally, 42% presenting before 3 mo nths of age and 25% of those first presenting when older than 3 months . All but one of the infants diagnosed prenatally had clinical signs a nd/or elevated serum creatinine in the early neonatal period. Eight ha d associated maternal oligohydramnios, of whom 6 presented prenatally and 2 postnatally: this factor was associated with a poor prognosis, w ith renal impairment persisting in 6 of these patients after treatment . Renal function did not relate consistently to the presence or otherw ise of vesicoureteric reflux (unilateral or bilateral). Twelve of the patients who presented postnatally had normal fetal ultrasonography la te in pregnancy, of whom 11 had upper tract dilatation when investigat ed. Six of these patients who currently have impaired renal function d id not have maternal oligohydramnios, and it is argued that antenatal detection of the condition would have been beneficial in less than 20% of patients presenting postnatally with posterior urethral valves.