Influence of Initial Therapy on Progression of Renal Failure and Body Growth in Children with Posterior Urethral Valves

Children with posterior urethral valves are at high risk for renal failure and growth retardation. It has been proposed that the type of initial surgical treatment (that is primary ablation versus high diversion) can affect the outcome of children with posterior urethral valves. We evaluated 43 children with posterior urethral valves treated and followed at our hospital from 1975 to 1990 (17 since birth and 26 referred patients). A total of 19 patients was treated by a high urinary diversion, (high urinary diversion group), 19 were treated by primary fulguration and 2 by vesicostomy (fulguration and vesicostomy group), and 3 underwent fulguration and unilateral diversion (mixed treatment group, excluded from study). The clinical outcome and body growth were compared for the high urinary diversion, and fulguration and vesicostomy groups. A normal stature (above the 25th percentile) was reached by 4 patients (21%) from the high urinary diversion group and 11 (52%) in the fulguration and vesicostomy group. This difference was not statistically significant. In contrast, renal function was predictive of body growth: 73% of the children with normal serum creatinine and 20% of the children with renal failure achieved a normal stature (p less than 0.05). One patient from the mixed treatment group died of pulmonary hypoplasia. We conclude that the type of primary surgical treatment (fulguration and vesicostomy or high urinary diversion) did not influence progression of renal failure or body growth in children with posterior urethral valves. Regardless of the surgical or medical treatment, which can greatly influence mortality, renal failure developed in almost 50% of the children with posterior urethral valves.