Vesicoureteral reflux in conjunction with posterior urethral valves.

PURPOSE

We evaluated the link between primary kidney function and vesicoureteral reflux in patients with posterior urethral valves. We also analyzed the timing of the resolution of reflux after release of urethral obstruction.

MATERIALS AND METHODS

We retrospectively analyzed records and x-ray results for 200 patients with posterior urethral valves treated at our institution between 1953 and 2003. Of these patients 197 were evaluated for vesicoureteral reflux.

RESULTS

Bilateral vesicoureteral reflux was present in 73 patients (37%) and unilateral reflux in 54 (27%). Of 99 cases of posterior urethral valves diagnosed postnatally the diagnosis was made at a younger age when reflux was present (p <0.001). Patients with reflux (especially bilateral) had significantly higher serum creatinine levels at presentation and 6 and 12 months postoperatively compared to patients without reflux. In unilateral cases the split functions of refluxing kidneys were significantly decreased. Reflux resolved spontaneously at a median of 1.28 years (range 0.04 to 15.16) after treatment of posterior urethral valves, resolving more rapidly in patients with unilateral disease. Among 200 poorly functioning kidneys 35 with reflux (18%) were removed.

CONCLUSIONS

In patients with posterior urethral valves vesicoureteral reflux is often associated with poorly functioning kidneys. Accordingly patients with bilateral reflux have decreased overall kidney function. Reflux resolves in half of ureters within 2 years after valve ablation. Reflux resolves more rapidly in unilateral cases.