SECTION ON UROLOGY 1996 ANNUAL MEETING PROGRAM

Background: In boys with posterior urethral valves (PUV's), nonfunctioning and poorly functioning kidneys are frequently removed early in life to improve voiding dynamics when associated with vesicoureteral reflux (VUR) and for control of infections. We have encountered boys with PUV's and unilateral poorly functioning kidneys usually associated with varying degrees of VUR and have managed these patients with nephrectomy, reimplantation and/or observation. We analyzed the eventual outcome of these patients in terms of clinical and urodynamic (UD) parameters in order to make some recommendations regarding their management. Methods: Over a 5 year period, we studied 33 patients with PUV's after valve ablation with serial multichannel urodynamic (UD) studies. Fourteen (42%) patients had unilateral poorly functioning kidneys (<10% of total renal function on nuclear renal scans) (8 left. 6 right), 12 of whom had VUR upon initial presentation Only these 14 patients were included in this report. Six of the 14 (43%) had been initially treated with transurethral valve ablation (TURV). 6 (43%) by vesicostomy followed by closure and TURV, and 2 (14%) by pyelostomy followed by closure and TURV. The 12 patients with ipsilateral VUR on initial presentation includes 7 grade 5, 2 grade 4 and 3 grade 3 VUR. All patients were followed as closely as possible with serial UD studies and aggressive medical management (anticholinergics, CIC, timed voiding, etc.) of abnormal UD parameters. Results: There were no clinical sequelae from not removing 11 of 14 kidneys with poor function. Three of 14 boys (21%), all initially treated with vesicostomy, required nephrectomy at a mean age of 21 months after a mean period of observation of 20 months because of recurrent infections and ipsilateral grade 5 VUR.