Association of concomitant congenital anomalies with long-term renal outcomes in children with posterior urethral valves.

backgroundPosterior urethral valves (PUV) are the most common cause of congenital bladder outlet obstruction in boys and may result in long-term impairment of both bladder and renal function. In addition to the obstructive process itself, concomitant congenital anomalies may further influence renal outcome. This study aimed to evaluate the spectrum of associated congenital anomalies in children with PUV and to examine their relationship with clinically significant chronic kidney disease (CKD) during follow-up.

methodsThis retrospective single-center observational study included 103 boys with cystoscopically confirmed PUV who were diagnosed and followed at the Pediatric Urology Clinic of Eskişehir Osmangazi University Faculty of Medicine between January 2014 and December 2024. Patients with incomplete records or follow-up shorter than 12 months were excluded. Demographic characteristics, antenatal findings, presenting symptoms, vesicoureteral reflux (VUR), associated anomalies, imaging findings, interventions, bladder assessment findings, and renal outcomes were reviewed. Descriptive statistical analysis was performed. Clinically significant CKD was defined as persistent estimated glomerular filtration rate (eGFR) < 90 mL/min/1.73 m² for more than 3 months, corresponding to CKD stage ≥ 2.

resultsThe median age at diagnosis was 2.4 years. Antenatal hydronephrosis and/or hydroureteronephrosis was present in 42 patients (40.8%), and concomitant VUR was detected in 39 (37.9%). Associated anomalies included hypospadias in 7 patients (6.8%), ureteropelvic junction obstruction in 7 (6.8%), renal hypodysplasia in 5 (4.9%), spina bifida in 5 (4.9%), anorectal malformation in 4 (3.9%), and trisomy 21 in 1 (1.0%). During follow-up, 8 patients (7.8%) developed CKD stage ≥ 2. Most of these patients had antenatal hydronephrosis, high-grade VUR, dysplastic or non-functioning kidneys, or additional congenital anomalies.

conclusionsIn this cohort, clinically significant CKD developed in a minority of children with PUV, but adverse renal outcome was concentrated in patients with severe upper urinary tract abnormalities and additional congenital anomalies. High-grade VUR, reduced functional renal mass, and complex associated anomalies appear to be important markers of poor renal prognosis. Careful long-term multidisciplinary follow-up remains essential in this patient group.