Sarhan Osama, Zaccaria Isabelle, Macher Marie-Alice, Muller Francoise, Vuillard Edith, Delezoide Anne-Lise, Sebag Guy, Oury Jean-Francois, Aigrain Yves, El-Ghoneimi Alaa
Service de Chirurgie et Urologie Pédiatrique, Université Paris 7, Hôpital Robert Debré, Assistance Publique Hôpitaux de Paris, Paris, France.
J Urol. 2008 Jan;179(1):307-12; discussion 312-3. doi: 10.1016/j.juro.2007.08.160. Epub 2007 Nov 19.
Management of posterior urethral valves is significantly modified by the prenatal diagnosis. Our aim was to assess long-term outcome of children with prenatally detected posterior urethral valves treated at our institution by primary valve ablation without routine urinary drainage or diversion.
A total of 79 cases of posterior urethral valves were detected prenatally at our hospital between 1987 and 2004. Of these cases 65 were managed postnatally, while pregnancy was terminated in 14. We studied the prenatal parameters of gestational age at diagnosis, renal parenchyma on ultrasound and amniotic fluid volume. Fetal urine was analyzed when indicated. Long-term outcome was assessed.
Primary valve ablation was done in all cases except 2. Median followup was 6.8 years (range 1 to 14.3). At the end of followup there were 11 cases of renal failure (17%) with 5 detected before 24 weeks of gestation, 6 cases of oligohydramnios and 9 cases of abnormal parenchyma. Gestational age at diagnosis and oligohydramnios were statistically significant predictors of final renal outcome (p = 0.003 and p = 0.02, respectively), while renal parenchymal changes were not (p = 0.23). When fetal urinalysis detected good prognosis (12 cases) renal failure developed in none, compared to 2 of the 3 cases with a bad prognosis. Continence was achieved in 42 of 55 toilet trained children (76%), 3 had nocturnal enuresis and 10 (18%) were incontinent.
Our long-term results of prenatally detected posterior urethral valves confirm that early valve ablation can be considered as the primary treatment in the majority of patients, without the need for preoperative drainage or diversion. Gestational age at diagnosis and volume of amniotic fluid are significant predictors of postnatal renal outcome.
产前诊断显著改变了后尿道瓣膜的治疗方式。我们的目的是评估在我院接受治疗的产前检测出后尿道瓣膜的患儿的长期预后，治疗方式为一期瓣膜消融术，不进行常规尿液引流或改道。
1987年至2004年间，我院共产前检测出79例后尿道瓣膜病例。其中65例在出生后接受治疗，14例终止妊娠。我们研究了诊断时的孕周、超声检查的肾实质和羊水量等产前参数。必要时对胎儿尿液进行分析，并评估长期预后。
除2例患者外，所有病例均接受了一期瓣膜消融术。中位随访时间为6.8年（范围1至14.3年）。随访结束时，有11例（17%）出现肾衰竭，其中5例在妊娠24周前被检测出，6例羊水过少，9例肾实质异常。诊断时的孕周和羊水过少是最终肾脏预后的统计学显著预测因素（分别为p = 0.003和p = 0.02），而肾实质改变则不是（p = 0.23）。当胎儿尿液分析显示预后良好时（12例），无一例发生肾衰竭，相比之下，3例预后不良的病例中有2例发生肾衰竭。55名接受如厕训练的儿童中有42名（76%）实现了控尿，3名有夜间遗尿，10名（18%）大小便失禁。
我们对产前检测出的后尿道瓣膜的长期研究结果证实，早期瓣膜消融术可被视为大多数患者的主要治疗方法，无需术前引流或改道。诊断时的孕周和羊水量是出生后肾脏预后的重要预测因素。
