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Post-obstructive diuresis after posterior urethral valve treatment in neonates: a retrospective cohort study

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Abstract

Background

The management of posterior urethral valve (PUV) in neonates requires close monitoring in the intensive care unit because of the risk of post-obstructive diuresis (POD). Our aim was to describe the incidence and factors associated with POD in newborns treated for PUV.

Methods

Retrospective analysis of the medical records of all neonates who underwent surgical intervention for PUV in our neonatal intensive care unit between January 2014 and April 2021.

Results

Of the 40 patients included, 15 (37.5%) had POD defined by urine output > 6 ml.kg−1.h−1 during the first 24 h following urinary tract obstruction relief. At prenatal ultrasound examinations, oligohydramnios was more common in the group with POD than in the group without (53.3% vs. 8%, p = 0.002). Preterm birth was more frequent in neonates with POD (66.7% vs. 8%; p < 0.001). Median serum creatinine (212 [137–246] vs. 95 [77–125] µmol.l−1; p < 0.001) and urea (8.5 [5.2–12.2] vs. 4.1 [3.5–4.7] mmol.l−1; p < 0.001) concentrations on the day of obstruction relief were significantly higher in the group with POD than in the group without. After adjustment for prematurity, logistic regression models confirmed correlation between the occurrence of POD and the severity of the consequences of urethral obstruction (i.e., oligohydramnios and serum creatinine levels; ß = 2.90 [0.88; 5.36], p = 0.013 and ß = 0.014 [0.003; 0.031], p = 0.034, respectively).

Conclusions

In neonates, POD is common after the relief of PUV-related obstruction. Our findings may help to identify patients at highest risk.

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Data availability

The data that support the findings of this study are available from the corresponding author upon reasonable request.

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Authors and Affiliations

  1. Department of Neonatal Intensive Care, AP-HP Hôpital Necker Enfants-Malades, 149 Rue de Sèvres, 75015, Paris, France

    Victor Sartorius, Agnès Giuseppi, Elise Leroy-Terquem, Elsa Kermorvant-Duchemin & Alexandre Lapillonne

  2. Department of Neonatal and Pediatric Intensive Care, CHU La Réunion, Saint-Pierre, France

    Silvia Iacobelli

  3. Université Paris Cité, Paris, France

    Victor Sartorius, Nicolas Vinit, Laurence Heidet, Thomas Blanc, Julien Stirnemann, Elsa Kermorvant-Duchemin & Alexandre Lapillonne

  4. Department of Pediatric Surgery and Urology, AP-HP Hôpital Necker Enfants-Malades, Paris, France

    Nicolas Vinit & Thomas Blanc

  5. Department of Obstetrics and Fetal Medicine, AP-HP Hôpital Necker Enfants-Malades, Paris, France

    Julien Stirnemann

  6. Department of Pediatric Nephrology, Reference Center for Inherited Renal Diseases (MARHEA), AP-HP Hôpital Necker Enfants-Malades, Paris, France

    Laurence Heidet

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  1. Victor Sartorius
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Sartorius, V., Giuseppi, A., Iacobelli, S. et al. Post-obstructive diuresis after posterior urethral valve treatment in neonates: a retrospective cohort study. Pediatr Nephrol 39, 505–511 (2024). https://doi.org/10.1007/s00467-023-06100-y

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