Isolated Posterior Urethral Valves and Anterior Urethral Valves With and Without Concomitant PUV: Matched Cohort Study at a High-risk Pediatric Center.

OBJECTIVE

To compare postnatal outcomes of anterior urethral valves (AUV) and posterior urethral valves (PUV) patients to evaluate for potential differences between these conditions, given that AUV with or without concomitant PUV is a rare congenital anomaly leading to lower urinary tract obstruction (LUTO).

METHODS

We reviewed our LUTO database and included patients with AUV or concomitant AUV+PUV, managed at our institution between 2003 and 2023 matching them to comparable PUV cases. Assessed variables included prenatal diagnosis, gestational age (GA) at birth, initial management, kidney function, presence and degree of hydronephrosis (HN), and need for renal replacement therapy (RRT).

RESULTS

The AUV ± PUV group (AUV: n = 11, concomitant PUV: n = 2) and PUV group (n = 26) had similar presenting ages and follow-up times (P >.05). Only 15.4% of AUV cases presented prenatally compared to 72.0% of PUV cases (P = .0016), leading to delayed postnatal management in AUV patients (P = .0260). Findings at presentation included UTI, weak stream or a palpable penile mass. PUV patients demonstrated significantly higher creatinine levels at the initial visit and at last follow-up (P = .0120 and P = .0302) than the AUV ± PUV group, with only 1 patient requiring RRT (P >.05). At the last follow-up, no patient in the AUV ± PUV group required clean intermittent catheterization compared to 37.5% in the PUV group (P = .0331) which also demonstrated more patients with persistent HN (P = .0039).

CONCLUSION

AUV with or without concomitant PUV is a rare finding that should be considered in patients presenting with weak stream, UTI, and penile swelling. Our data suggest potential differences in presentation and less severe postnatal outcomes in AUV compared to PUV patients.