Long-term prognosis of renal function in boys treated for posterior urethral valves

This paper discusses the long-term prognosis of renal function in 84 boys t reated for posterior urethral valves and followed up for a period ranging f rom 1-21 years. Thirty-one of the 84 patients (39.3%) were either adolescen ts or had crossed adolescence and this study highlights the changes through adolescence and puberty. Serum creatinine was found to be raised in 53% patients at presentation and 22.5% patients eventually progressed to chronic renal failure. Serum creat inine value 1 year after appropriate decompression of the urinary tract was a more accurate predictor of the eventual renal outcome rather than serum creatinine at presentation. Decompensation at puberty was detected in 3 patients in this study. The pre disposing factors identified were the persistence of gross hydroureteroneph rosis with voiding dysfunction after treatment in one patient and renal par enchymal disease in the other 2 patients. The "risk factors" for predicting a poor eventual renal function were persi stently raised serum creatinine 1 year after decompression by diversion or fulguration, bilateral high grade vesicoureteral reflux, persistent severe upper tract dilatation after treatment, voiding dysfunction and delayed pre sentation. This study emphasizes the need to diagnose and intervene early, to investig ate post-treatment persistent upper tract dilatation fbr vesicoureteral jun ction obstruction and for detrusor dysfunction by a complete urodynamic eva luation and to follow up these patients carefully through adolescence and a dulthood.