Does early upper tract diversion and delayed undiversion in megaureters secondary to severe posterior urethral valves lead to better renal outcomes?
Background: There are conflicting reports for the management of severe posterior urethral valve (PUV) after ablation. The primary objective was to assess the renal outcomes using the estimated glomerular filtration rate (eGFR) and secondary outcomes in severe PUVs who underwent early partially diver...
| Main Authors: | , |
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| Format: | Article |
| Language: | English |
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Wolters Kluwer Medknow Publications
2022-01-01
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| Series: | Journal of Indian Association of Pediatric Surgeons |
| Subjects: | |
| Online Access: | http://www.jiaps.com/article.asp?issn=0971-9261;year=2022;volume=27;issue=2;spage=196;epage=203;aulast=Prathap |
| _version_ | 1811342888300183552 |
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| author | Somnath Prathap Sarath Kumar Narayanan |
| author_facet | Somnath Prathap Sarath Kumar Narayanan |
| author_sort | Somnath Prathap |
| collection | DOAJ |
| description | Background: There are conflicting reports for the management of severe posterior urethral valve (PUV) after ablation. The primary objective was to assess the renal outcomes using the estimated glomerular filtration rate (eGFR) and secondary outcomes in severe PUVs who underwent early partially diverting reduction ureterostomy (PDRU) and a delayed undiversion protocol.
Materials and Methods: This 10-year retrospective study reviewed the records of 1094 boys with PUV, where severe PUV cases were treated with early PDRU (324 surgeries). We then analyzed those patients who completed the early diversion and delayed undiversion protocol. The long-term renal outcomes using eGFR and antero-posterior diameter (APD) were compared at various time points using appropriate statistical methods.
Results: Of the 171 severe PUV patients who underwent PDRU, 31 completed undiversion and 26 (47 renal units) were analyzed after exclusions. The mean age (standard deviation) at presentation was 1.46 ± 4.1 months. Thirty-two units were refluxing and 15 were nonrefluxing megaureters. PDRU was closed at a mean age of 3.9 years and had a mean duration of follow-up of 6.4 years. The mean eGFR increased from a minimum of 10.78 ± 10.25 at baseline and remained stable at 28.69 ± 18.89 after closure of both stoma. Similarly, mean APD decreased from 12.07 ± 6.79 at the diagnosis to 7.00 ± 6.20. Three patients (3 renal units) required revision of the stoma for stenosis and 1 patient had a parastomal hernia that was repaired at the time of undiversion.
Conclusions: In severe PUVs, early PDRU with delayed undiversion is a reliable surgical option that may ensure better renal outcomes in the long-term. Nonrefluxing renal units recover better than the refluxing. APD measurements also are shown to improve favorably. |
| first_indexed | 2024-04-13T19:20:00Z |
| format | Article |
| id | doaj.art-5130a92d98474d018c3262eadf4905cc |
| institution | Directory Open Access Journal |
| issn | 0971-9261 1998-3891 |
| language | English |
| last_indexed | 2024-04-13T19:20:00Z |
| publishDate | 2022-01-01 |
| publisher | Wolters Kluwer Medknow Publications |
| record_format | Article |
| series | Journal of Indian Association of Pediatric Surgeons |
| spelling | doaj.art-5130a92d98474d018c3262eadf4905cc2022-12-22T02:33:34ZengWolters Kluwer Medknow PublicationsJournal of Indian Association of Pediatric Surgeons0971-92611998-38912022-01-0127219620310.4103/jiaps.JIAPS_366_20Does early upper tract diversion and delayed undiversion in megaureters secondary to severe posterior urethral valves lead to better renal outcomes?Somnath PrathapSarath Kumar NarayananBackground: There are conflicting reports for the management of severe posterior urethral valve (PUV) after ablation. The primary objective was to assess the renal outcomes using the estimated glomerular filtration rate (eGFR) and secondary outcomes in severe PUVs who underwent early partially diverting reduction ureterostomy (PDRU) and a delayed undiversion protocol. Materials and Methods: This 10-year retrospective study reviewed the records of 1094 boys with PUV, where severe PUV cases were treated with early PDRU (324 surgeries). We then analyzed those patients who completed the early diversion and delayed undiversion protocol. The long-term renal outcomes using eGFR and antero-posterior diameter (APD) were compared at various time points using appropriate statistical methods. Results: Of the 171 severe PUV patients who underwent PDRU, 31 completed undiversion and 26 (47 renal units) were analyzed after exclusions. The mean age (standard deviation) at presentation was 1.46 ± 4.1 months. Thirty-two units were refluxing and 15 were nonrefluxing megaureters. PDRU was closed at a mean age of 3.9 years and had a mean duration of follow-up of 6.4 years. The mean eGFR increased from a minimum of 10.78 ± 10.25 at baseline and remained stable at 28.69 ± 18.89 after closure of both stoma. Similarly, mean APD decreased from 12.07 ± 6.79 at the diagnosis to 7.00 ± 6.20. Three patients (3 renal units) required revision of the stoma for stenosis and 1 patient had a parastomal hernia that was repaired at the time of undiversion. Conclusions: In severe PUVs, early PDRU with delayed undiversion is a reliable surgical option that may ensure better renal outcomes in the long-term. Nonrefluxing renal units recover better than the refluxing. APD measurements also are shown to improve favorably.http://www.jiaps.com/article.asp?issn=0971-9261;year=2022;volume=27;issue=2;spage=196;epage=203;aulast=Prathapcystoscopic ablationglomerular filtration rateposterior urethral valverenal failureureterostomyvesicostomy |
| spellingShingle | Somnath Prathap Sarath Kumar Narayanan Does early upper tract diversion and delayed undiversion in megaureters secondary to severe posterior urethral valves lead to better renal outcomes? Journal of Indian Association of Pediatric Surgeons cystoscopic ablation glomerular filtration rate posterior urethral valve renal failure ureterostomy vesicostomy |
| title | Does early upper tract diversion and delayed undiversion in megaureters secondary to severe posterior urethral valves lead to better renal outcomes? |
| title_full | Does early upper tract diversion and delayed undiversion in megaureters secondary to severe posterior urethral valves lead to better renal outcomes? |
| title_fullStr | Does early upper tract diversion and delayed undiversion in megaureters secondary to severe posterior urethral valves lead to better renal outcomes? |
| title_full_unstemmed | Does early upper tract diversion and delayed undiversion in megaureters secondary to severe posterior urethral valves lead to better renal outcomes? |
| title_short | Does early upper tract diversion and delayed undiversion in megaureters secondary to severe posterior urethral valves lead to better renal outcomes? |
| title_sort | does early upper tract diversion and delayed undiversion in megaureters secondary to severe posterior urethral valves lead to better renal outcomes |
| topic | cystoscopic ablation glomerular filtration rate posterior urethral valve renal failure ureterostomy vesicostomy |
| url | http://www.jiaps.com/article.asp?issn=0971-9261;year=2022;volume=27;issue=2;spage=196;epage=203;aulast=Prathap |
| work_keys_str_mv | AT somnathprathap doesearlyuppertractdiversionanddelayedundiversioninmegaureterssecondarytosevereposteriorurethralvalvesleadtobetterrenaloutcomes AT sarathkumarnarayanan doesearlyuppertractdiversionanddelayedundiversioninmegaureterssecondarytosevereposteriorurethralvalvesleadtobetterrenaloutcomes |