What are the follow-up guidelines for patients with posterior urethral valves?

Follow-up Guidelines for Posterior Urethral Valves

Long-term follow-up of patients with posterior urethral valves (PUV) is mandatory, with monitoring of kidney, bladder, and sexual functions continuing into adulthood to detect and manage complications.

Initial Post-Treatment Monitoring

• Urethrography should be performed every two weeks until complete healing following surgical intervention 1
• Urinary drainage with urethral catheter is mandatory in adult patients after surgical management 2
• Suprapubic cystostomy is recommended for pediatric patients following surgical repair 1, 2
• CT scan with delayed phase imaging is the method of choice for follow-up of associated bladder injuries 2, 3

Long-Term Renal Function Monitoring

• Regular assessment of renal function through creatinine clearance is essential as chronic renal failure occurs in 54.1% of patients with PUV in long-term follow-up 4
• Monitor for hypertension, which develops in approximately 37.5% of patients with PUV 4
• End-stage renal disease can develop in up to 20.8% of patients, necessitating dialysis or renal transplantation 4
• Follow-up imaging is driven by the patient's clinical condition, particularly in cases with moderate to severe renal injuries 1

Urinary Tract Monitoring

• Lower urinary tract symptoms persist in approximately 29.1% of patients into adulthood 4
• Regular assessment of bladder function through uroflowmetry with ultrasound post-void residual urine measurement 4
• Voiding cystourethrography (VCUG) remains the gold standard for diagnosis and follow-up of vesicoureteral reflux, which is common in PUV patients 1
• Contrast-enhanced voiding urosonography (ceVUS) is an alternative to VCUG for follow-up to reduce radiation exposure 1

Special Considerations for Different Age Groups

• For patients diagnosed within the first year of life, continuous antibiotic prophylaxis is recommended regardless of the grade of reflux or presence of focal uptake defects on radionuclide scan 1
• For children aged 1-5 years, initial medical management is strongly recommended 1
• Immediate parenteral antibiotic treatment should be offered for febrile breakthrough infections 1
• Patients diagnosed after age 1 may have a lower risk of developing renal insufficiency on long-term follow-up, but still require regular monitoring 5

Fertility and Sexual Function Monitoring

• Sexual function should be monitored into adulthood as part of comprehensive follow-up 4
• While significant fertility deficits and sexual dysfunction are uncommon (observed in only 1 out of 24 patients in long-term follow-up), fertility potential should still be assessed 4

Common Pitfalls to Avoid

• Failure to maintain long-term follow-up beyond childhood and adolescence may miss late complications 4
• Inadequate monitoring of renal function may lead to undetected progression of renal insufficiency 4, 6
• Insufficient attention to bladder dysfunction can result in urinary incontinence and recurrent urinary tract infections 7, 6
• Relying solely on symptom resolution without objective testing may miss subclinical deterioration 6

Follow-up Schedule

• Regular follow-up visits should continue throughout childhood, adolescence, and into adulthood 4
• Renal function tests and blood pressure measurements should be performed at each follow-up visit 4
• Imaging studies (ultrasound, VCUG or ceVUS) should be performed periodically based on clinical findings 1, 6
• Urodynamic studies may be necessary in patients with persistent voiding dysfunction 6