Outcome of PUV Patients Following Ablation in a Tertiary Teaching Hospital in Addis Ababa, Ethiopia

Abstract

Hiwote G Assefa,1 Hanna Getachew,2 Amezene Tadesse,2 Woubedel Kiflu,2 Fisseha Temesgen,2 Belachew Dejene,2 Tihitena Negussie Mammo2 1Department of Surgery, St Paul’s Hospital, Millennium Medical College, Addis Ababa, Ethiopia; 2Department of Surgery, Addis Ababa University School of Medicine, Addis Ababa, EthiopiaCorrespondence: Hiwote G Assefa; Tihitena Negussie Mammo Email [email protected]; [email protected]: Posterior urethral valve (PUV) is the most common cause of congenital lower urinary tract obstruction in boys. It is considered that early diagnosis and intervention have good outcomes in terms of renal function, though the varying extent of embryological insult requires these boys to remain in extended follow-up and care.Objective: To assess the renal outcome of patients following PUV ablation.Methods: This was a descriptive retrospective study. Data were collected from the operation logbooks of patients from 2015 to 2019 that had been admitted to the Tikur Anbessa Specialized Hospital pediatric surgery unit with a working diagnosis of PUV and had ablation done primarily or following diversion. Data were collected from January to April 2020 and analyzed using SPSS 25. P value≤ 0.05 was considered significant.Results: Seventy patients were analyzed and followed for 3 years for the development of postoperative chronic kidney disease (CKD) after PUV ablation. Postoperative CKD was found in 52.9% of patients and end-stage renal disease in 2.9%. Risk factors associated with postoperative CKD were the presence of preoperative and postoperative proteinuria, postoperative hypertension, and elevated nadir serum creatinine. Results also showed that a delay between the development of vesicostomy and ablation had a significant correlation with renal outcome. Elevated nadir serum creatinine, postoperative proteinuria, and delay between the development of vesicostomy and ablation were found to be independent risk factors of development of CKD.Conclusion: There was a high rate of CKD development in patients who had had ablation for PUV, which was comparable to other studies. Three variables were found to be independent risk factors for the progression of CKD, unlike other findings seen in low- and middle-income countries.Keywords: posterior urethral valve, primary ablation, vesicostomy, nadir serum creatinine, proteinuria, chronic kidney disease, end-stage renal disease

Keywords

• posterior urethral valve
• primary ablation
• vesicostomy
• nadir serum creatinine
• proteinuria
• chronic kidney disease. end stage renal disease