Presentation Authors: Oluwaseye Ayoola Ogun, John Makari*, Omaha, NE
Introduction: Posterior urethral valve (PUV) is a congenital abnormality of the urethra that affects 1 in 5,000 to 8,000 males and is the leading cause of bladder outlet obstruction in male infants and of end-stage renal disease in pediatric patients. The purpose of this study is to understand treatment trends for the management of posterior urethral valve in US freestanding childrenâ€™s hospitals.
Methods: Patient records from male patients admitted to a PHIS hospital between 1995 and 2014 within two weeks of birth and who have both an ICD-9 diagnosis and procedure code consistent with posterior urethral valve were evaluated. Patients whose records indicate a diagnosis code consistent with prune belly syndrome, neurogenic bladder and anorectal malformation were excluded. Data including primary and subsequent interventions, timing of interventions and hospital region based on the American Urological Associationâ€™s sections were collected. Data analysis was performed using SPSS.
Results: Records from 346 unique patients were identified. During this 20-year period, a shift from cutaneous vesicostomy to endoscopic valve ablation was observed as the most commonly performed initial intervention for PUV. Endoscopic valve ablation was the most common initial intervention for PUV in all geographic regions. Initial intervention was performed at a median age of 8 days. Secondary interventions within the first year of life were performed in 5.2% of patients; 50% of these patients had nephrostomy performed as their initial intervention. 0.9% of patients required three procedures within the first year of life. The median length of stay was 16 days and the 30-day readmission rate was 11.3% for these patients. At discharge, mortality for patients who underwent intervention for PUV was 3.8%.
Conclusions: Over this 20-year period primary endoscopic valve ablation has emerged as the treatment of choice for PUV in US freestanding childrenâ€™s hospitals. Additional interventions are performed infrequently in the first year of life, but most commonly in patients who underwent nephrostomy as their initial intervention. These data provide insight into treatment trends for PUV.