URETHRAL VALVES DURING THE FIRST YEAR OF LIFE - A RETROSPECTIVE, MULTICENTER STUDY

The diagnoses, treatment, and clinical courses of 178 children with urethral valves were analyzed in a retrospective, multicenter study. In group I the diagnosis had been made during the first 4 weeks of life, in group II between the 2nd and 12th months of life, after which treatment was begun. Statistical analysis of the patient data and results revealed clearly poorer results for patients in group I, who had the most severe congenital abnormalities: 10% of the infants in group I died within the 1st year of life as compared to 1% in group II. Among the survivors, 25 % of children in group I had renal insufficiency as opposed to 8.2 % in group II. The following parameters proved to be statistically significant risk factors with regard to prognosis. 1. Birth weight 2. Age at diagnosis 3. Renal function, particularly when initial creatinine levels exceed 200 mu mol/l and fail to decrease below 100 mu mol/l after successful therapy 4. Bilateral grade IV or V vesicoureteral reflux 5. Late incontinence (after conclusion of the 5th year of life). Statistical significance could be demonstrated for parameters 1-4, but due to the small number of patients not for parameter 5. The study showed that numerous neoimplantations associated with high complication rates were carried out in both groups, however, no statististically significant effect on long-term prognosis could be established. Our results did not confirm those of the Toronto group, who proposed that broadening the indications for supravesical urinary diversion would provide demonstrable parenchymal protection. No statistically significant relationship between therapeutic procedure and long-term clinical course could be shown. According to the literature, poor results are found in 40 % of patients treated during the Ist year of Life after long-term follow-up of 20 and more years (Parkhouse et al). The results of the present study appear more favorable, as poor results were found in only 20 % of these children after 5 years' follow-up. The authors assume, however, that after a further 10-20 years renal function in these patients will be similar to that in Parkhouse's study. The results of this study indicate that resection of urethral valves as early as possible is of particular importance to long-term prognosis.