Jaureguizar E, López Pereira P, Martínez Urrutia M J, Bueno J, Espinosa L, Navarro M
Unidad de Urología Pediátrica, Dpto. de Cirugía Pediátrica, Hospital Infantil La Paz, Madrid.
Cir Pediatr. 1994 Jul;7(3):128-31.
Long-term outcome of 35 boys with severe posterior urethral valves is reviewed, with intention to know if the course of renal function depended on initial treatment and bladder dysfunction. Diagnosis was established during the first month in 15 patients, before one year in 16 and later in 4. Surgical management was initially, upper urinary tract diversion (pyeloureterostomy) in 19 patients (group A) and valve ablation in 15 (group B). The average age for closure of temporary urinary diversion was 17 months. Follow-up ranged from 4-19 years (mean 8.3 years). Twenty one patients had a urodynamic study years after initial treatment and this study showed 8 normal bladder, 7 unstable and 6 non-compliant. In group A, at the end of study, 13 patients (70%) have a glomerular filtration of more than 80 ml/min/1.72 m2 while in group B only 6 (37.5%) and average height after treatment was higher in patients of group A. Noncompliant bladders had worst prognosis (66% renal failure) than unstable bladders (25%) and the prognosis was improved in these types of bladders when initial treatment was upper tract diversion. The results of our study suggest that in patients with severe posterior urethral valves, the renal function improved with early diversion (pyeloureterostomy) and irreversible bladder dysfunction worsen the prognosis in these patients.
回顾了35例重度后尿道瓣膜男孩的长期预后情况，旨在了解肾功能的病程是否取决于初始治疗及膀胱功能障碍。15例患者在出生后第1个月确诊，16例在1岁前确诊，4例在更晚的时候确诊。手术治疗起初，19例患者（A组）采用上尿路改道（肾盂输尿管造口术），15例（B组）进行瓣膜切除术。临时尿路改道关闭的平均年龄为17个月。随访时间为4至19年（平均8.3年）。21例患者在初始治疗多年后进行了尿动力学研究，该研究显示8例膀胱功能正常，7例不稳定，6例顺应性差。在A组，研究结束时，13例患者（70%）的肾小球滤过率超过80 ml/min/1.72 m2，而B组仅6例（37.5%），且A组患者治疗后的平均身高更高。顺应性差的膀胱预后（66%肾衰竭）比不稳定膀胱（25%）更差，当初始治疗为上尿路改道时，这类膀胱的预后有所改善。我们的研究结果表明，对于重度后尿道瓣膜患者，早期改道（肾盂输尿管造口术）可改善肾功能，而不可逆的膀胱功能障碍会使这些患者的预后恶化。
