Ultrasound Insights: Alpha Blockers’ Impact on Hydronephrosis & Kidney Function in Posterior Urethral Valves

Posterior urethral valves (PUV) are a common pediatric urological issue contributing to chronic kidney disease (CKD). Limited studies, involving small cohorts, have suggested potential benefits of α-blockers in improving bladder emptying and reducing hydronephrosis. However, no research has explored their impact on slowing CKD progression. This study hypothesized that α-blocker therapy reduces the severity or progression of CKD to stage 3 or higher (CKD≥3). A 10-year retrospective analysis of 286 pediatric PUV patients was conducted, focusing on 167 patients with at least three follow-up visits. Key parameters included sonographic Society for Fetal Urology (SFU) scores, glomerular filtration rate (GFR), creatinine, cystatin C, and use of α-blockers or anticholinergics. Cox regression analysis revealed a significant association between α-blockers and delayed progression to CKD≥3 (p=0.039), with a hazard ratio indicating a 54.5% reduced risk. Notably, α-blockers significantly reduced hydronephrosis severity over time (Bayes factor=0.006), making it 70 times more likely to lower hydronephrosis grades compared to no treatment. The timing of valve resection and pre-ablation creatinine levels did not significantly impact CKD progression when accounting for α-blockade. Anticholinergics showed no similar protective effects (p=0.201). These findings highlight the potential of α-blockers to slow CKD progression and improve hydronephrosis in PUV patients, emphasizing their value regardless of surgical intervention timing. Incorporating ultrasound monitoring into routine follow-up enables accurate assessment of hydronephrosis changes and therapeutic impact.