Clinical Outcomes of Primary Valve Ablation Versus Urinary Diversion in Infants With Posterior Urethral Valves: A Prospective Cohort Study

Background: Posterior urethral valves (PUV) are a congenital condition affecting the male urinary tract and characterised by membranous folds in the posterior urethra, presenting as the most common cause of lower urinary tract obstruction in paediatric patients. Primary valve Ablation (PVA) and urinary diversion (UD) are the treatment choices depending on the patient's condition and the surgeon's understanding. Objective: The current study aimed to evaluate the clinical outcomes of PVA versus UD in male children under the age of one year. Methods: The prospective cohort study included 110 patients, with 55 in each of the PVA and UD intervention groups. After three months of follow-up the outcomes, voiding dysfunction, urine dribbling, straining, slow stream, recurrent Urinary Tract Infections (UTIs), predictors of chronic kidney disease (CKD), as albumin excretion and Glomerular filtration rate (GFR), were evaluated. Results: Mean age was 6.89±3.07 months, albumin excretion 24.50±10.13 mg/day, and GFR 76.46±18.34/ml/min/1.73m2 in participants. Duration of surgery in PVA was 25.40±5.47 minutes and 129.94±18.44 minutes in UD. Recurrent UTIs were reported in 19.1%, urine dribbling in 38.2%, urine straining in 19.1%, and a slow stream of urine in 28.2% participants. No significant difference was reported in urine dribbling P=0.578, urine slow stream P=0.289, and urine straining P=0.089. Recurrent UTIs, P=0.04, were significant with OR=2.22 in the UD group as compared to PVA. Albumin excretion P=0.776 and GFR P=0.487 were insignificant. Age of the child had a significant negative association with Albumin excretion r= -0.288, P=0.002 and a moderate negative association with GFR r=-0.346, P<0.001. Conclusion: There was no significant difference in clinical outcomes of PVA versus UD at three-month follow-up, in terms of CKD and voiding dysfunction, except recurrent UTIs reported two times higher in the UD group. The study limitation was short followup, a single centre investigation and lower sample size.