Impact of a standardized care pathway and a dedicated multidisciplinary posterior urethral valve clinic on 5-year kidney and bladder outcomes.

Abstract

Background: Posterior urethral valves (PUV) are a rare congenital condition leading to chronic kidney disease (CKD) and bladder dysfunction. Traditional management is often reactive and non-standardized. In 2019, we implemented a dedicated multidisciplinary PUV clinic with a standardized, proactive management pathway to optimize kidney and bladder outcomes. This study evaluates its impact over 5 years.

Methods: We conducted a retrospective review of our prospectively maintained PUV database, including patients diagnosed before 24 months and managed exclusively at our institution. Outcomes were compared between patients managed in the PUV clinic (aPUV) to patients before implementation (bPUV). Primary outcomes included kidney function (serum creatinine, eGFR, CKD progression, and kidney replacement therapy). Secondary outcomes assessed bladder function, including medications, catheterization, and urinary tract infections.

Results: A total of 196 patients were analyzed (bPUV: 133; aPUV: 63). The aPUV cohort had earlier interventions and a higher rate of primary urinary diversion (54% vs. 11%; p < 0.01). The aPUV group had lower nadir serum creatinine (21 vs. 29 μmol/l; p < 0.01), reduced CKD progression (12% vs. 27%; p = 0.02), and fewer patients requiring kidney replacement therapy (3% vs. 20%; p < 0.01). Earlier bladder therapy initiation led to reduced hydronephrosis and timelier catheterization.

Conclusion: A standardized PUV clinic and proactive management approach significantly improved kidney and bladder outcomes at 5 years. If sustained, this strategy may delay CKD progression and reduce the need for kidney replacement therapy. Longer follow-up is needed to assess long-term impact.