Atlas of predictive tools and scoring systems for outcomes in patients with posterior urethral valves: A comprehensive review of the literature.

Abstract

Posterior urethral valves (PUVs) are a common cause of congenital bladder outlet obstruction and obstructive uropathy in male infants and are a leading cause of chronic kidney disease (CKD)/end-stage renal failure (ESRF) in the pediatric population. Despite this, it remains challenging to predict which patients will go on to develop CKD/ESRF, and thus management and follow-up are left to the discretion of the treating department. Many different methods have been proposed to predict outcomes in these patients and several tools, including predictive scores and models, have been published. Here, we provide an up-to-date summary of the tools currently published. A comprehensive search of literature available on MEDLINE and Google Scholar was performed to identify scoring systems, predictive models, and predictive tools relating to progression to CKD/ESRF/bladder dysfunction in patients with PUVs. Six predictive tools were identified and so were included in the analysis. Three are based on clinical/biochemical findings, 2 utilize machine learning/artificial intelligence, and one is purely based on radiological findings. Three out of 6 have undergone some form of external validation. Four provide a numerical risk and 2 stratify patients into risk categories. There are currently 6 predictive tools that have been published that quantify the risk of developing long-term complications associated with PUVs. Further validation is required to establish these scores/predictive models as a clinical standard of care.