Correlation Between Posterior/Anterior Urethral Ratio from Voidingcystourethrography and Prognosis of Posterior Urethral Vales

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Pokket Sirisreetreerux
Pocharapong Jenjitranant
Chinnarat Hongyok
Ratanaporn Pornkul
Wit Viseshsindh


Purpose: To determine the correlation between the posterior/anterior urethral caliber ratio and the renal and bladder function after definite rreatment for posterior urethral valves (PUV). and to evaluate the prognostic variables affecting the renal function in the patients with PUV.

Material and Method: We retrospectively reviewed the medical records and voiding cystourethrography (VCUG) of the patients who were diagnosed as having PUV from January 2004 to June 2013. The Posterior/anterior urethral caliber ratio was measured from VCUG at diagnosis and the data including age at diagnosis, clinical presentation of the disease, degree of vesicoureteral reflux (VUR), temporary urinary diversion type, renal function at diagnosis, the best renal function after temporary urinary diversion and at the latest visit were collected.

Results: Of 20 patients, mean±SD of age at dianosis was 22.6±28.4 months (range 0.03-84 monts). Mean±SD of posterior/anterior urethral caliber ratio at the time of diagnosis was 3.4±1.64 (range 1.3-6.4). Mean±SD of glomerrular filtration rate (GFR) at diagnosis and at the latest visit were 39.5±39.7 ml/min/1.73m2 and 87.7±50.3 ml/min/1.73 m2 , respectively. VUR was found in 27 renal units. Valve bladder syndrome (VBS) was diagnosed in 13 patients (68%). No correlation was found between the posterior/anterior urethral caliber ratio and renal function at various time, and also between the uretharll ratio and VBS. Only GFR nadir after diversion was related to the outcome of renal function. 

Conclusion: Although the posterior/anterior urethral caliber ratio was not correlated with the renal function and bladder fuction after treatment of PUV, the significant factors that could predict the renal function after treatment was serum GFR after temporary urinary diversion. 

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Sirisreetreerux, P., Jenjitranant, P., Hongyok, C., Pornkul, R., & Viseshsindh, W. (1). Correlation Between Posterior/Anterior Urethral Ratio from Voidingcystourethrography and Prognosis of Posterior Urethral Vales. Ramathibodi Medical Journal, 39(1), 62-71. Retrieved from
Original Articles


1. Nasir AA, Ameh EA, Abdur-Rahman LO, Adeniran JO, Abraham MK. World J Pediatr. 2011;7(3):205-16. doi:10.1007/s12519-011-0289-1.

2. Jaureguizar, E., López-Pereira, P. & Martinez-Urrutia, M.J. The valve bladder: etiology and outcome. Curr Urol Rep. 2002;3:115-20. doi:10.1007/s11934-002-0021-8.

3. Penna FJ, Elder JS. CKD and bladder problems in children. Adv Chronic Kidney Dis. 2011;18(5):362-9. doi:10.1053/j.ackd.2011.08.001.

4. Ali-El-Dein B, Abol-Enein H, El-Husseini A, Osman Y, Shehab El-Din AB, Ghoneim MA. Renal transplantation in children with abnormal lower urinary tract. Transplant Proc. 2004;36(10):2968-73.

5. Hulbert WC, Rosenberg HK, Cartwright PC, Duckett JW, Snyder HM. The predictive value of ultrasonography in evaluation of infants with posterior urethral valves. J Urol. 1992;148(1):122-4.

6. Warshaw BL, Hymes LC, Trulock TS, Woodard JR. Prognostic features in infants with obstructive uropathy due to posterior urethral valves. J Urol. 1985;133(2):240-3.

7. Sarhan OM, El-Ghoneimi AA, Helmy TE, Dawaba MS, Ghali AM, Ibrahiem el-HI. Posterior urethral valves: multivariate analysis of factors affecting the final renal outcome. J Urol. 2011;185(6 Suppl):2491-5. doi:10.1016/j.juro.2011.01.023.

8. Ansari MS, Singh P, Mandhani A, et al. Delayed presentation in posterior urethral valve: long-term implications and outcome. Urology. 2008;71(2):230-4. doi:10.1016/j.urology.2007.09.037.

9. El-Sherbiny MT, Hafez AT, Shokeir AA. Posterior urethral valves: does young age at diagnosis correlate with poor renal function? Urology. 2002;60(2):335-8.

10. Parkhouse HF, Barratt TM, Dillon MJ, et al. Long-term outcome of boys with posterior urethral valves. Br J Urol. 1988;62(1):59-62.

11. Churchill BM, Khoury AE, McLorie GA. Posterior urethral valves. Acta Urologica Belgica. 1989;57:435-49.

12. Bani Hani O, Prelog K, Smith GH. A method to assess posterior urethral valve ablation. J Urol. 2006;176(1):303-5.

13. Gupta RK, Shah HS, Jadhav V, et al. Urethral ratio on voiding cystourethrogram: a comparative method to assess success of posterior urethral valve ablation. J Pediatr Urol. 2010;6(1):32-6. doi:10.1016/j.jpurol.2009.05.009.

14. Menon P, Rao KL, Vijaymahantesh S, et al. Posterior urethral valves: Morphological normalization of posterior urethra after fulguration is a significant factor in prognosis. J Indian Assoc Pediatr Surg. 2010;15(3):80-6. doi:10.4103/0971-9261.71744.

15. Bomalaski MD, Anema JG, Coplen DE, Koo HP, Rozanski T, Bloom DA. Delayed presentation of posterior urethral valves: a not so benign condition. J Urol. 1999;162(6):2130-2.

16. DeFoor W, Clark C, Jackson E, Reddy P, Minevich E, Sheldon C. Risk factors for end stage renal disease in children with posterior urethral valves. J Urol. 2008;180(4 Suppl):1705-8. doi:10.1016/j.juro.2008.03.090.

17. Ansari MS, Gulia A, Srivastava A, Kapoor R. Risk factors for progression to end-stage renal disease in children with posterior urethral valves. J Pediatr Urol. 2010;6(3):261-4. doi:10.1016/j.jpurol.2009.09.001.

18. Bajpai M, Dave S, Gupta DK. Factors affecting outcome in the management of posterior urethral valves. Pediatr Surg Int. 2001;17(1):11-5.

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