Home About us Current issue Back issues Submission Instructions Advertise Contact Login   

Search Article 
  
Advanced search 
 
Saudi Journal of Kidney Diseases and Transplantation
Users online: 379 Home Bookmark this page Print this page Email this page Small font sizeDefault font size Increase font size 
 

ORIGINAL ARTICLE Table of Contents   
Year : 2001  |  Volume : 12  |  Issue : 4  |  Page : 516-519
Presentation of Posterior Urethral Valves in Saudi Arabia in the 90's


1 Division of Urology, King Khalid University Hospital, Riyadh, Saudi Arabia
2 Division of Pediatric Urology, King Faisal Specialist Hospital, Riyadh, Saudi Arabia
3 Division of Urology, King Fahad National Guard Hospital, Riyadh, Saudi Arabia
4 Division of Urology, Security Forces Hospital, Riyadh, Saudi Arabia

Click here for correspondence address and email
 

   Abstract 

To evaluate the age and mode of presentation of patients with posterior urethral valves (PVU) in the antenatal and postnatal periods, we analyzed the files of 108 patients with the diagnosis of PUV in four referral hospitals in Riyadh, Saudi Arabia from 1989 to 1999. Of the study patients, 29 (27%) were antenatally discovered, 41 (38%) in the first year of life and 38 (35%) after the first year of life. The mode of presentation was by antenatal ultrasound in 29 (27%) patients, urinary tract infection in 33 (30.4%) patients, poor urinary stream in 35 (32.4%) patients, retention of urine in neonatal life in eight (7.4%) patients and symptoms of renal impairment in three (2.8%) patients. We conclude that the antenatal detection rate of PUV in our study patients is less than the international one (70%), despite the fact that most of the antenatal follow-ups were done in centers where ultrasound was available for routine antenatal work up. This calls for more vigilance by the radiologists and obstetricians to enhance the rate of detection of PUV.

Keywords: Posterior urethral valves, Antenatal diagnosis, Antenatal ultrasound, Saudi Arabia, Renal failure, Congenital urogenital anomalies, Antenatal hydronephrosis, Children, Renal ultrasound.

How to cite this article:
Neel KF, El-Faqih SR, De Castro R, Abu Daia JM, Al-Shammari AM, Al-Jasser A, Al-Farraj H. Presentation of Posterior Urethral Valves in Saudi Arabia in the 90's. Saudi J Kidney Dis Transpl 2001;12:516-9

How to cite this URL:
Neel KF, El-Faqih SR, De Castro R, Abu Daia JM, Al-Shammari AM, Al-Jasser A, Al-Farraj H. Presentation of Posterior Urethral Valves in Saudi Arabia in the 90's. Saudi J Kidney Dis Transpl [serial online] 2001 [cited 2020 Jun 3];12:516-9. Available from: http://www.sjkdt.org/text.asp?2001/12/4/516/33544

   Introduction Top


Although posterior urethral valves (PUV) is not a common disease (1:5000 births), [1] its sequalae on the bladder function and the growing renal tissue [2] makes it one of the most challenging diseases and it may carry a mortality rate of 50%. [3]

The routine use of antenatal ultrasound in pregnant women has improved the antenatal diagnosis of bilateral hydronephrosis to 60­70% [4] enabling early treatment soon after birth, which has helped to reduce the mortality to 5%. Unfortunately, 50% of those who survive may develop renal impairment. [5]

This is a retrospective study of 108 patients with PUV managed at four referral hospitals in Riyadh, Saudi Arabia whose aim is to find the age and mode of presen­tation and the antenatal detection rate of PUV.


   Material and Methods Top


The medical files of 108 patients with PUV seen at four referral hospitals in Riyadh, Saudi Arabia (King Khalid University Hospital, King Fahad National Guard Hospital, King Faisal Specialist Hospital and Research Center and Security Forces Hospital) in the period from 1989 to 1999 were reviewed. Of all the study patients, only 25 (23%) were followed antenatally in the above-mentioned hospitals. The remaining 83 patients (77%) were referred from other hospitals in the Kingdom.

The data obtained included the age at presentation, the mode of presentation, the presence and degree of upper urinary tract dilatation at presentation and the differential renal function seen in the first renal DMSA scan.

According to the age at presentation, the study patients were classified into three groups: Group I when the diagnosis was suspected on antenatal ultrasound, Group II first year of life and group III after the first year of life. The mode of presentation was classified as:

1). routine antenatal detection,

2). urinary tract infection (UTI),

3). poor urinary stream,

4). urine retention in neonatal life,

5). symptoms of renal impairment.

Renal dilatation was classified according to the Society of Fetal Urology grading system [6] as 1) No or minimal dilatation Grade (G 0 or GI), 2) moderate dilatation (G2 & G3), and 3) severe dilatation (G4).

Impairment of renal function was considered when the first differential renal scan (DMSA) showed a decrease of 35% or more of uptake of isotope. [7]


   Results Top


The age of presentation, the mode of presentation, and the degree of renal dilatation are shown in [Table - 1],[Table - 2],[Table - 3] respectively. Of the study patients, 29 (27%) were antenatally discovered, 41 (38%) discovered in the first year of life and 38 (35%) discovered after the first year of life. The mode of presentation was by antenatal ultrasound in 29 (27%) patients, urinary tract infection in 33 (30.4%) patients, poor urinary stream in 35 (32.4%) patients, retention of urine in neonatal life in eight (7.4%) patients and symptoms of renal impairment in three (2.8%) patients.

Differential renal scan (DMSA) done at presentation in the 216 kidneys involved, showed reduction or loss of function in 102 (47%).


   Discussion Top


The anomalies of the urogenital system are the most common antenatally diagnosed congenital anomalies (14:1000 births). [8] The wide spread use of antenatal ultrasound as a routine test in pregnancy has improved the antenatal diagnosis of such anomalies, in particular hydronephrosis, enabling the urologists to intervene early. [8],[9],[10],[11],[12],[13] .

Corteville et al [14] found postnatal studies were warranted if the antero-posterior renal pelvic diameter was > 7mm on the antenatal ultrasound after 33 weeks, or > 4mm before 33 weeks of gestation. Although the presence of oligohydramios and distended bladder is very suggestive of PUV, their presence is not always diagnostic for such diagnosis. All patients with antenatal hydronephrosis, should have VCUG routinely soon after birth. [15]

Despite the availability of the ultrasound as a part of antenatal work up of pregnant women in almost all the hospitals in the Kingdom, only 29 patients (27%) in our group were diagnosed antenatally and the rest (79) patients (73%) were missed. This detection rate of 27% is far less than the internationally accepted detection rate reported in the literature (60-70%). [4]

Posterior urethral valves being an uncommon anomaly (1:5000 birth)[1] does not make it less important. Its effect on the upper urinary tract with the associated significantly high incidence of renal impairment in up to 50% [3] of the cases makes it one of the most challenging diseases to treat and calls for early detection. [4] Since obstructive uropathies are the commonest cause of renal failure needing dialysis in the pediatric age group in the Kingdom, [16] it is mandatory for the radiologists and obstetricians to be more vigilant during the antenatal follow-up of pregnant mothers to the possibility of this condition.

Obstetricians are encouraged to perform a routine antenatal ultrasound after the 28 th week of gestation, [8],[9],[10],[11],[12],[13] and all neonates with antenatally diagnosed hydronephrosis should be covered with antibiotics soon after birth, [13] and properly investigated to define the anomaly. [13] In addition, all children with urinary tract infection should be thoroughly investigated by ultrasound and voiding cystourethrogram. [2]

We conclude that the antenatal detection rate of PUV in our study patients is less than the international one (70%), despite the fact that most of the antenatal follow­ups were done in centers where ultrasound was available for routine antenatal work up. This calls for more vigilance by the radiologists and obstetricians to enhance the rate of detection of PUV.

 
   References Top

1.Casale AJ. Early ureteral surgery for posterior urethral valves. Urol Clin North Am 1990;17:361-72.  Back to cited text no. 1  [PUBMED]  
2.Gonzales ET Jr. Posterior urethral valves and other urethral anomalies. In: Gillen­water JY, Grayhack JT, Howards SS, Duckett JW Jr, eds. Adult and Pediatric Urology. 3 rd ed. St Louis. Mosby 1996: 1872-92.  Back to cited text no. 2    
3.Churchill BM, Krueger RP, Fleisher MH, Mardy BE. Complications of posterior urethral valve surgery and their prevention. Urol Clin North Am 1983;10:519-30.  Back to cited text no. 3    
4.Greenfield SP. Posterior urethral valves- new concepts. J Urol 1997;157:996-7.  Back to cited text no. 4  [PUBMED]  
5.Mitchell ME, Close CE. Early primary valve ablation for posterior urethral valves. Semin Pediatr Surg 1996;5:66-71.  Back to cited text no. 5  [PUBMED]  
6.Kogan BA. The fetus with obstructive uropathy: Alternative approaches In: Harrison M, Gabus M, Filly R, eds. The unborn patient. 2nd ed. Philadelphia, Saunders 1990:399-402.  Back to cited text no. 6    
7.Majd M. Nuclear Medicine in Pediatric Urology. Kelalis P, King L, Belman AB, eds. Clinical Pediatric Urology. W.B. Sunders Company 3 rd edition 1992:117-65.  Back to cited text no. 7    
8.Gunn TR, Mora JD, Pease P. Antenatal diagnosis of urinary tract abnormalities by ultrasonography after 28 weeks' gestation: Incidence and outcome. Am J Obstet Gynecol. 1994;172:479-86.  Back to cited text no. 8    
9.Dinneen MD, Dhillon HK, Ward HC, Duffy PG, Ransley PG. Antenatal diagnosis of posterior urethral valves. Br J Urol 1993;72:364-9.  Back to cited text no. 9  [PUBMED]  
10.Gunn TR, Mora JD, Pease P. Outcome after antenatal diagnosis of upper urinary tract dilatation by ultrasonography. Arch Dis Child 1988;63:1240-3.  Back to cited text no. 10  [PUBMED]  
11.Helin I, Persson PH. Prenatal diagnosis of urinary tract abnormalities by ultrasound. Pediatrics 1986;78:879-83.  Back to cited text no. 11  [PUBMED]  
12.Close CE, Carr MC, Burns MW, Mitchell ME. Lower urinary tract changes after early valve abstation in neonates and infants: is early diversion warranted? J Urol 1997;157:984-8.  Back to cited text no. 12  [PUBMED]  
13.Hutton KA, Thomas DF, Davies BW. Prenatally detected posterior urethral valves: qualitative assessment of second trimester scans and prediction of outcome. J Urol 1997;158:1022-5.  Back to cited text no. 13  [PUBMED]  [FULLTEXT]
14.Corteville JE, Gray DL, Crane JP. Congenital hydronephrosis: correlation of fetal ultrasonographic findings with infant outcome. Am J Obstet Gynecol 1991;165: 384-8.  Back to cited text no. 14  [PUBMED]  
15.Blyth B, Synder HM, Duckett JW. Antenatal diagnosis and subsequent management of hydronephrosis. J Urol 1993;149:693-8.  Back to cited text no. 15    
16.Al-Salloum AA, Al-Mugeiren MM, Al­Rasheed S, Al-Mazrou A, Al-Zamil F. CAPD in Saudi Arabian children: ten years experience from a single center. Saudi J Kidney Dis Transplant 1997;8(3):298-301.  Back to cited text no. 16    

Top
Correspondence Address:
Khalid Fouda Neel
Consultant Pediatric Urologist, Department of Surgery (37), King Khalid University Hospital, P.O. Box 7805, Riyadh 11472
Saudi Arabia
Login to access the Email id


PMID: 18209395

Rights and Permissions



 
 
    Tables

  [Table - 1], [Table - 2], [Table - 3]



 

Top
 
 
    Similar in PUBMED
    Search Pubmed for
    Search in Google Scholar for
  Related articles
    Email Alert *
    Add to My List *
* Registration required (free)  
 


 
    Abstract
    Introduction
    Material and Methods
    Results
    Discussion
    References
    Article Tables
 

 Article Access Statistics
    Viewed4806    
    Printed83    
    Emailed0    
    PDF Downloaded342    
    Comments [Add]    

Recommend this journal