ORIGINAL RESEARCH article
Front. Pediatr.
Sec. Pediatric Urology
Volume 13 - 2025 | doi: 10.3389/fped.2025.1584878
Defining Post-Obstructive Diuresis Following Posterior Urethral Valve Ablation
Provisionally accepted
- Children's Hospital of Los Angeles, Los Angeles, United States
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Posterior urethral valves (PUV) are the most common cause of congenital lower urinary tract obstruction. Patients are at risk for post-obstructive diuresis (POD) following management of this obstruction which may prolong and/or complicate their subsequent hospital course.Despite this known physiologic effect, there is minimal data to define which patients are at highest risk for POD. Our objective was to define an initial urine output threshold for neonatal post-obstructive diuresis. A retrospective chart review was conducted on patients that were admitted to our Newborn and Infant Critical Care Unit (NICCU), in a tertiary care children's hospital, between 2004-2019 and underwent cystoscopic valve ablation for PUV. Outcomes of interest were length of hospital stay after posterior urethral valve ablation, serum creatinine and electrolyte values, fluid intake, and urine output at 4-and 24-hours post-valve ablation. Chisquared, Fisher's exact, and T-tests were conducted for descriptive statistical analyses as appropriate. Logistic regression analyses were conducted with adjusted models including patient demographic and clinical data. 40 patients met inclusion criteria and the mean age at time of valve ablation was 11.2 days. Pre-operatively, maximum creatinine levels (ng/dl) achieved had a median value of 0.7 (IQR: 0.5-1.5). Post-operatively, the mean urine output (mL/kg/hr) at 4hours was 4.2 ± 3.7, and at 24-hours was 4.5 ± 2.2. Logistic regression analyses showed that those with a post-operative 24-hour UOP > 3.5 ml/kg/hr had more than 5 times the odds of a prolonged hospital length of stay (LOS) > 3 days (OR: 5.50; 95% CI: 1.23-24.51). Our findings suggest greater urine output after ablation to be a predictor of increased hospital length of stay.Utilizing a urine output (UOP) of >3.5 mL/kg/hr may serve as a useful starting point for defining POD after posterior urethral valve ablation.
Keywords: posterior urethral valves, Post-obstructive diuresis, urethral valve ablation, Urinary obstruction, pediatric urology
Received: 27 Feb 2025; Accepted: 23 Jun 2025.
Copyright: © 2025 Lavoie, Chun, Do, Baker, Friedlich and Chang. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Brian Chun, Children's Hospital of Los Angeles, Los Angeles, United States
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