Summer Scholarship Projects 2011-2012
Project Name: Long term outcomes of children with posterior urethral valves: a systematic review of prognostic indicators
The research project will be undertaken at the Centre for Kidney Research at the Children’s hospital at Westmead
For more information contact: Dr Ani Deshpande
Description of Project:
Posterior urethral valves are congenital folds of tissue found in the posterior urethra distal to the urinary bladder and cause urinary outflow obstruction. They are the commonest cause of congenital bladder outlet obstruction (BOO) and are responsible for significant long-term nephron-urological morbidity (approximately 10% of children with ESRD). They are increasingly being diagnosed on antenatal ultrasonography.
A significant proportion of children born with posterior urethral valves progress to chronic renal insufficiency in teenage or early adulthood. Effective treatment in infancy may minimise the risk of renal insufficiency in the future however the risk of end stage renal disease due to in utero damage to kidneys (dysplasia) cannot be eliminated. Endoscopic ablation of a posterior urethral valve is the current gold standard of therapy. Besides, it has recently become evident that children with PU valves have a risk of ongoing renal damage even after successful early treatment, due to a number of factors, the chief being bladder dysfunction.
The complex and varying dysfunction of urinary bladder in children who have undergone the treatment for PU valves has been called a valve bladder syndrome (VBS).The exact proportion of children with PU valves who eventually develop VBS remains speculative due to lack of systematic prospective longitudinal studies.
There have been a handful of studies which report long term follow-up of children with posterior urethral valve. A few prognostic markers have been well studied in moderate sized cohort studies. However, there is a need for high level evidence regarding prognostic markers which will assist clinical decision making and patient counselling. We aim to provide a multivariate prognosis model for patients with posterior urethral valves and to provide an improved understanding of disease progression.
This study will involve a comprehensive search to identify all relevant studies. The student will contribute as a co-author on the manuscript for publication in an international, peer reviewed clinical journal. They will acquire valuable transferable research skills in literature searching and screening, critical appraisal of clinical practice guidelines, coding of textual data using specialist computer software, presentations, reference management and manuscript writing. The student will also have an opportunity to collaborate with expert leaders in the field.
