ESPN 51th Annual Meeting

ESPN 2018


 
The effect of bladder dysfunction on renal function in patients with posterior urethral valve: the preliminary data
EMRE GOK 1 SEHA SAYGILI 1 NUR CANPOLAT 1 MEHMET ELICEVIK 2 SEBUH KURUGOGLU 3 CENK BUYUKUNAL 2 LALE SEVER 1 SALIM CALISKAN 1 HALUK EMIR 2

1- ISTANBUL UNIVERSITY CERRAHPASA FACULTY OF MEDICINE, DEPARTMENT OF PEDIATRIC NEPHROLOGY
2- ISTANBUL UNIVERSITY CERRAHPASA FACULTY OF MEDICINE, DEPARTMENT OF PEDIATRIC UROLOGY
3- ISTANBUL UNIVERSITY CERRAHPASA FACULTY OF MEDICINE, DEPARTMENT OF PEDIATRIC RADIOLOGY
 
Introduction:

Bladder dysfunction is considered to contribute to the development of late-onset chronic kidney disease (CKD) in patients with posterior urethral valve (PUV). The aim of the present study was to evaluate bladder dysfunction and to investigate the relationship between urodynamic changes and renal function in patients with PUV.

Material and methods:

Fifty patients with PUV [mean age 10 (1.1-22) years and follow-up duration 109 (11-240) months] who had an invasive urodynamic examination above the age of 1 year were included in the study. Clinical characteristics, serum creatinine levels, radiological findings and invasive urodynamic parameters [bladder capacity (BC), presence of overactive detrusor contractions, maximal voiding pressure (PvesQmax), voiding pattern and post-void residual (PVR) volume] in the first urodynamic examinations were retrospectively recorded. All clinical, radiological and urodynamic parameters were evaluated regarding their effects on eGFR. 

Results:

The ratio of antenatal diagnosis was 58%. Median (IQR) operation time was 1.05 (0.5;2.0) months in antenatally diagnosed patients and 20.9 (5.2;48.1) months in postnatally diagnosed patients. Thirteen patients (27%) had bilateral and 13 (27%) unilateral upper urinary tract dilation. Twenty-four patients (51%) had VUR. The median (IQR) age at the time of urodynamic studies was 4.6 (1.7;8.1) years. Twelve percent of patients had a small BC while 44% had a large BC. Twenty-seven patients (56%) had overactive detrusor contraction and 26 patients (72%) showed an increased voiding pressure (>60 mmHg). Thirty-four patients (68%) showed an increase in PVR volume. Mean GFR was 94±41 ml/min/1.73m2 at the last visit and 57% of the patients were on stages 2-4 of CKD. Decrease in GFR was significantly associated with the presence of bilateral upper urinary tract dilation (p=0.018) and the increased PVR (p=0.024). 

Conclusions:

This preliminary study reveals that the majority of the patients with PUV had bladder dysfunction according to the urodynamic examination. Increased PVR appears to be a significant risk factor for decreased GFR.