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        Which Patients Are at Higher Risk for Residual Valves After Posterior Urethral Valve Ablation?

        Mehdi Shirazi,Mohamadreza Farsiani,Mohammad Natami,Kiomars Izadpanah,Amir Malekahmadi,Abbasali Khakbaz 대한비뇨의학회 2014 Investigative and Clinical Urology Vol.55 No.1

        Purpose: To find patients at high risk of obstructive remnant leaflets after valve ablationamong boys with posterior urethral valve (PUV), we evaluated any possible relationshipbetween preoperative findings in our patients and residual obstructive leafletsafter valve ablation. Materials and Methods: We retrospectively reviewed the medical records of 55 patientswith PUV that was treated by the same surgeon between 2008 and 2012. Of these, 37patients (67.3%) had no obstructive remnant leaflets (group A) and 18 patients (32.7%)had obstructive remnant leaflets (group B) in follow-up cystoscopy. Preoperative clinicaland radiological findings were evaluated and compared between the groups. Results: Among all the preoperative data we examined, the analysis revealed that ageat the time of surgery (median age: group A, 15 months; group B, 7 months; p=0.017),echogenicity of kidneys (p<0.05), presence of vesicoureteral reflux (p<0.05), and gradeof reflux (p<0.05) were significantly different between the groups. Method of valveablation, anterior-posterior diameters of the renal pelvis, renal cortical thickness, bladderwall thickening, and scarring on the dimercaptosuccinic acid scan showed no significantdifferences between the two groups. Conclusions: In our patients, younger age at surgery time, hyperechogenicity of renalparenchyma, presence of vesicoureteral reflux, and grade 4 or 5 reflux before surgeryhad a significant relationship with residual valves. More studies may result in enhancedmanagement of patients at high risk of residual valves after PUV ablation, becausethe sooner the obstruction is resolved entirely, the better the outcome.

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