Comparative Outcomes of Early Versus Delayed Surgery in Posterior Urethral Valves in Infants

Muhammad Musa Kakar; Asadullah; Ali Nawaz; Sana Ullah Kakar

doi:10.70749/ijbr.v3i5.2443

Authors

Muhammad Musa Kakar Department of Urology, Sandeman Provincial Hospital (SPH) & Bolan Medical College (BMC), Quetta, Balochistan, Pakistan.
Asadullah Department of Urology, Sandeman Provincial Hospital (SPH) & Bolan Medical College (BMC), Quetta, Balochistan, Pakistan.
Ali Nawaz Department of Urology, Sandeman Provincial Hospital (SPH) & Bolan Medical College (BMC), Quetta, Balochistan, Pakistan.
Sana Ullah Kakar Balochistan Institute of Psychiatry and Behavioral Sciences (BIPBS), Quetta, Balochistan, Pakistan.

DOI:

https://doi.org/10.70749/ijbr.v3i5.2443

Keywords:

Posterior Urethral Valves (PUV), Early Surgery, Delayed Surgery, Renal Function, Bladder Dysfunction, Paediatric Urology, Chronic Kidney Disease (CKD).

Abstract

Background: The most frequent cause of congenital lower urinary tract obstruction in male babies is posterior urethral valves (PUV), which frequently leads to bladder and kidney failure. Because different results regarding renal recovery and postoperative problems have been described in the literature, there is ongoing discussion regarding the best time to perform surgical correction: early in the newborn period or after stability. Objective: To compare the outcomes of early versus delayed surgical intervention in infants with PUV, focusing on renal function improvement, complication rates, urinary tract infection (UTI) recurrence, and long-term bladder function. Methods: A qualitative comparative observational study was conducted over one year at a tertiary care hospital in Quetta, Pakistan. A total of 120 male infants diagnosed with PUV (confirmed by cystoscopy or VCUG) were divided into two groups Early surgery group (n=60): underwent valve ablation or urinary diversion within the neonatal period (≤1 month). Delayed surgery group (n=60): had surgery more than a month following stabilization.

Semi-structured interviews with children surgeons, urologists, and caretakers were used to gather information about bladder outcomes, renal improvement, postoperative recovery, and UTI recurrence. Prior to the start of the trial, informed permission and ethical approval were acquired. Results: The baseline characteristics of the two groups were similar. Higher eGFR improvement (68% vs. 55%) and lower mean serum creatinine (0.9 ± 0.3 mg/dL vs. 1.2 ± 0.4 mg/dL) were indicators of greater renal function recovery in the early intervention group. The early group experienced CKD development less frequently (16.6% vs. 28.3%). Additionally, there was a decrease in UTIs and postoperative readmissions (20% and 13.3% in early instances versus 33% and 23.3% in delayed cases). In 75% of early instances, normal voiding was attained, whereas in 60% of delayed cases, and recovery satisfaction as stated by caregivers was higher (90% vs. 77%). Conclusion: Compared to delayed surgery, early surgical intervention in babies with PUV leads to greater bladder function, less comorbidities, and superior renal outcomes. In newborns, early valve ablation presents considerable long-term advantages despite technical difficulties. To maintain kidney function and improve overall prognosis, prompt diagnosis and prompt treatment are crucial.

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