PURPOSE: Children born with a persistent cloaca undergo complex pelvic reconstruction early in their life.
Long-term risks of bladder dysfunction and chronic kidney disease (CKD) are well described. In this study, we report upper urinary tract outcomes and the risk of CKD stage progression.
METHODS: A retrospective cohort study was performed of all patients undergoing posterior sagittal anorecto-vagino-urethroplasty (PSARVUP) at a single institution from 2006-13. Inclusion criteria included complete urological care at our institution. CKD stage was calculated from cystatin C or nuclear medicine GFR.
RESULTS: 44 patients met inclusion criteria. 12 patients had a vesicostomy or ureterostomy. 19 had hydronephrosis, 19 had VUR, and 15 had a tethered spinal cord. Median length of the common channel was 3.5 cm. Median age at PSARVUP was 7.3 months. Median follow-up was 5.3 years. 30 patients had a neurogenic bladder. 27 require CIC, and 3 patients have a vesicostomy. 38 patients had CKD Stage I or II. 5 patients had CKD stage III, and 1 had CKD Stage IV. In the follow-up period, no patients with initial CKD stage I to III have had stage progression. The one patient with CKD Stage IV had a renal allograft placed at 34 months of age prior to the need for dialysis.
CONCLUSIONS: In this series, early outcomes in patients with chronic kidney disease stage I to III show that renal function can be maintained despite a high rate of lower urinary tract dysfunction. Aggressive bladder management may help prevent progressive renal injury in this population.
Written by:
DeFoor WR, Bischoff A, Reddy P, VanderBrink B, Minevich E, Schulte M, Sheldon C, Pena A. Are you the author?
Divisions of Pediatric Urology and the Alberto Pena Colo-rectal Center, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
Reference: J Urol. 2015 Jan 23. pii: S0022-5347(15)00170-6.
doi: 10.1016/j.juro.2015.01.080
PubMed Abstract
PMID: 25623743