Neonatal perirenal urinary extravasation with posterior urethral valves

Renal dysplasia and atrophy are associated with congenital urinary tract obstruction, such as posterior urethral valves, and are thought to result from the increased pressure in the developing obstructed urinary system. This increased pressure is likely to be alleviated by perirenal urinary extravasation and urinary ascites. Whether this relief of pressure in the obstructed developing kidney results in a lessened degree of renal abnormality is likely to depend on the time during the period of gestation when the urinary leak occurs and the degree of renal dysplasia and atrophy at the time of the urinary leak.     

Spontaneous perirenal urinoma during nephritic colic

A case has been reported of the spontaneous rupture of the kidney during an attack of nephritic colic. This rare complication is due to excessive pressure in the renal cavities caused by an obstructive ureteral calculus. Complete resolution of the urinoma was obtained after endoscopic fragmentation of the calculus and double J stenting.     

Congenital posterior urethral valves in an adult

An adult male with posterior urethral valves who had obstructive urinary symptoms and painless gross hematuria is presented. The diagnosis, development, and treatment of posterior urethral valves is discussed. The importance of also treating the hypertrophied bladder neck is stressed.     

Neonatal solitary renal cysts associated with posterior urethral valves.

Large simple cysts of the kidney are common findings in adults but are extremely rare in neonates. Three cases of large solitary renal cysts in newborn boys associated with posterior urethral valves are described. The pathogenesis, diagnosis, treatment, and differentiation from urinoma secondary to spontaneous urinary extravasation are discussed.     

Persistent severe hypertension in an infant with posterior urethral valves

Severe hypertension, an infrequent problem in pediatrics, usually has a single secondary cause. We report an infant with severe hypertension and left reflux nephropathy, a known cause of secondary hypertension. The severity of hypertension and poor response to pharmacological therapy prompted further investigation, including a renal arteriogram that showed a right segmental renal artery stenosis. Received December 15, 1995; received in revised form June 11, 1996; accepted June 24, 1996     

Cryptorchidism in boys with posterior urethral valves

A review of 207 male children with poterior urethral valves revealed an over-all incidence of cryptorchidism of 12 per cent. This association of cryptorchidism in boys with posterior urethral valves has not been described previously.     

Renal transplantation in children with posterior urethral valves

We compared retrospectively the outcome of renal transplantation in 18 children with a diagnosis of posterior urethral valves to 18 matched children with nonobstructed renal failure to identify the disadvantages of renal transplantation into the valve bladder. There was no statistical difference in patient survival. The 5-year graft survival rate was 62.3% in children with posterior urethral valves and 48% in the control group. The difference was not statistically significant (p = 0.32). A statistically significant increase in serum creatinine from 1.2 to 2.2 mg./dl. was noted in the patients with posterior urethral valves, which was not seen in the control group (p = 0.0009). The clinical significance of this finding is unknown. Renal transplantation can be performed successfully in patients with posterior urethral valves. A prospective study is required to determine the benefits of preoperative lower urinary tract urodynamic assessment and the true effect of the valve bladder.     

Renal transplantation in children with posterior urethral valves

The objective of this study was to analyze whether renal transplantation (RT) in children with posterior urethral valves (PUV) constitutes a special group with respect to groups with different etiologies of end-stage renal disease (ESRD). Between 1979 and 2004, 22 RT were performed in 19 children with PUV. The median age at RT was 10 years (range: 1.3–17). Immunosuppression was provided by triple therapy and polyclonal/monoclonal antibodies. This group was compared with the two control groups: (1) glomerulopathy (n=62) and (2) pyelonephritis/dysplasia (n=42) without lower urinary tract disease, transplanted in the same period. Ten graft losses occurred in 22 transplants: thrombosis (2), acute rejection (3), chronic graft nephropathy (2), and death of patients (3) with a functioning graft in the 1st postoperative month. We did not find significant differences versus the control group in renal function or probability of graft or patient survival at 1, 5, and 10 years. We observed a greater risk of urological complication in patients with PUV. RT with PUV constitutes a special group due to the compulsory young age and the need for careful and complex medicosurgical management; nevertheless, the results achieved were similar to those obtained in our general RT population.     

Renal impairment in children with posterior urethral valves

Background

Posterior urethral valves (PUV) are a common cause of end-stage renal failure in childhood. Our aim was to describe a cohort of patients with PUV and to investigate the predictors of renal impairment.

Methods

We performed a retrospective chart review of children with PUV who were followed at King Abdulaziz University hospital between 2002 and 2011.

Results

The cohort comprised 68 boys. There was a significant difference in the duration of follow-up (p?=?0.024), nadir serum creatinine (p?<?0.001), and last known serum creatinine level (p?=?0.001) between the patients with and without renal impairment. The duration of follow-up appeared to be a significant predictor for serum creatinine doubling (p?=?0.003; odds ratio, 1.8). There was no difference in the age of presentation, age at the time of the study, and first or last serum creatinine between children who initially had vesicostomy and children who had ablation.

Conclusions

Ablation of PUV or vesicostomy did not influence kidney function in our study cohort. Children with a normal nadir serum creatinine who presented early had a better outcome.     

Aspects concerning posterior urethral valves

Twenty-six boys were evaluated and treated for posterior urethral valves. At the time the valves were diagnosed unilateral or bilateral vesicoureteral reflux was present in 58% of the ureters and 69% of the children, while dilatation of the upper urinary tract was present in 88% and 92%, respectively. There was a variety of symptoms and signs, but the most prominent in neonates and infants were vesical urine retention, palpable kidneys and failure to thrive, whereas in the older children voiding dysfunction, incontinence and urinary infection were the most common. Twenty-four out of 26 boys were managed by primary valve ablation and in 62.5% of them this type of treatment was adequate in resolving or sufficiently improving clinical manifestations and roentgenologic findings, requiring no further management. Urinary diversion in the form of vesicostomy and cutaneous ureterostomy was preserved for those patients who did not improve with valve ablation alone. The current aspects concerning posterior urethral valves are also discussed.     

Protective factors in posterior urethral valves

Patients with posterior urethral valves may present with or contract renal insufficiency. High intravesical pressure that is transmitted to the upper urinary tract in utero is a likely contributing cause. We have identified 3 anatomical associations with posterior urethral valves that provide a pressure "pop-off" mechanism resulting in preservation of better renal function: 1) the syndrome of posterior urethral valves, unilateral vesicoureteral reflux and renal dysplasia; 2) large congenital type bladder diverticula and 3) urinary extravasation with or without urinary ascites. Followup of 71 boys with posterior urethral valves was sufficient to permit long-term analysis. Serum creatinine was used as an index of renal function and prognosis. Of the 71 boys 20 (28 per cent) had 1 of the 3 protective mechanisms. Only 1 child (5 per cent) had a serum creatinine greater than 1.0 mg. per cent. Of the remaining 51 boys without a "pop-off" mechanism 20 (39 per cent) had serum creatinine greater than 1.0 mg. per cent and 7 had already progressed to renal dialysis and/or transplantation. The difference in serum creatinine was statistically significant (p less than 0.01). Thus, the syndrome of posterior urethral valves, unilateral vesicoureteral reflux and renal dysplasia; large congenital bladder diverticula and urinary extravasation can serve as a "pop-off" mechanism to buffer high pressures in the urinary tract and to lead to the preservation of better renal function in boys with posterior urethral valves.