[Posterior urethral valves: prognosis related to the initial surgical treatment].

Long-term outcome of 32 boys with severe posterior urethral valves is reviewed. Diagnosis was established during the first month of life in 14 patients, along the first year in another 14 and later in five. Surgical management was, initially, bilateral upper urinary tract diversion (cutaneous ureterostomy or pyelostomy) in 17 patients (Group A), and valve ablation alone or vesicostomy in 15 children (Group B). Eight months was the mean age of patients at initial surgery (40% before the first month of life). The average age for closure of the temporary urinary diversion was 17 months. Eleven patients underwent later unilateral nephrectomy and eighteen antireflux surgical procedures. Follow-up ranged from 1 to 15 years (mean 6 years). Fifteen patients have a Glomerular Filtration Rate (G.F.R.) of more than 80 ml./min./1.73 m2. Eleven (73%) of them underwent early upper urinary tract diversion, and the remaining four (27%) underwent valve ablation or vesicostomy. Two children among the 32 have developed end stage renal disease. Average height and weight posttreatment values were higher in those patients treated with ureterostomy or pyelostomy. The results of our study suggest that renal function improved in patients with early upper urinary tract diversion.