Role of Temporary End Uretrostomies in Advance Cases of Posterior Urethral Valve Obstruction Presenting with Chronic Renal Failure

Objective: Our study aims at determining the effectiveness of surgical protocol in the management of advanced cases of posterior urethral valve in improving the GFR. Study Design Setting: This is interventional study conducted at the Pediatric Surgery Department, B.V Hospital Bahawalpur from May 2008 to May 2011. Materials Methods: In a total of 46 cases of congenital obstructive uropathy fulfilling the inclusion and exclusion criteria temporary end uretrostomies were performed. Urine complete examination, S.creatinine level and ultrasonography were done every 3 months and radionucleoid renal scan, every 6 months after the primary surgery up to average 18 months. After the follow up of 18 months ureter re-implantation was performed. In cases of posterior urethral valves, the valve ablation was done at the time of ureter reimplantation. Results: Out of total 46 cases 27(58.6%) were less 2 year of age and 19(41.4%) were above 2 year age with mean age ±SD was 4.95±3.37 year. 43(93%) were male and 3(7%) were female. GFR of all the patients was recorded that was 21.35 ml ±6.21 (mean ±SD) from prior to ureterostomies and at the end of study after 18 months GFR was 65.35 ±11.77m. Five cases shoed no improvement in GFR so referred to nephrologist/transplant surgeon. Four cases (8.7%) were lost during follow up and 37(80.43%) children underwent definitive surgery Conclusion:Temporary end uretrostomies in cases of primary congenital obstructive uropathy with Grade IV or V vesicoureteric reflux is effective procedure in temporizing higy grade vesico ureteric reflux and the children who developed chronic renal failure.