Abstract
ABSTRACTPurpose:Posterior urethral valves (PUVs) are the most common cause of congenital bladder obstruction in boys. Our aim was to assess the impact of early diagnosis and fulguration of PUVs on bladder function and compare their functional and urodynamic outcome with children who underwent delayed intervention.Materials and Methods:We retrospectively evaluated 153 patients who underwent primary valve ablation from two tertiary hospitals between 2001 and 2018. Patients have been divided into 2 groups, group 1 included 69 patients who were detected antenatally and underwent early fulguration of PUVs while group 2 included 84 children presented postnatally and underwent delayed valve ablation. The recorded data throughout follow-up in renal function tests, urodynamics and changes in the upper urinary tracts were evaluated and compared.Results:Median age at time of valve ablation was 10 days in group 1 and 7 months in group 2. The median follow-up period was 6.5 and 7 years in group 1 and 2, respectively. Chronic kidney disease (CKD) developed in 15 (22%) boys in group 1 while in group 2 it was observed in 31 (37%), p=0.04. While Q-max, mean bladder capacity and post-void residual (PVR) volumes were comparable in both groups, percent PVR was significantly higher in group 2 (3.27 vs. 1.44, p=0.002). Detrusor overactivity was slightly different in both groups (p = 0.07).Conclusions:Compared to delayed intervention, primary ablation of PUVs during the early neonatal life possibly provides the optimum chance to have optimum renal function without impact on bladder function.
Highlights
Posterior urethral valves (PUVs) are the most common cause of lower urinary tract obstruction in male neonates [1]
The follow-up period ranged from 2 to 15 years with a median follow-up of 6.5 years (IQR, 3-9) and it was comparable between both groups
Bladder outlet obstruction caused by PUVs in early life leads to a mixture of structural, functional, and biochemical changes that will judge the evolution of the bladder function later in a child’s life and may persist even after the relief of obstruction [6, 7, 20]
Summary
Posterior urethral valves (PUVs) are the most common cause of lower urinary tract obstruction in male neonates [1]. Some cases can be missed during antenatal screening and present after birth with a wide range of symptoms. The functional impact of PUVs on the lower urinary tract ranges from mild bladder dysfunction to urinary incontinence, and the latter was found in over 20% of children 1 year after valve ablation [4]. Voiding dysfunction was reported in up to 75% of boys with PUVs [5]. It originates in utero, after infravesical obstruction brought about by the valve and usually remains during infancy and through adolescence, even after valve ablation [6, 7]. Impairment of kidney function is sometimes progressive, and despite successful valve ablation, approximately one third of PUVs patients develop chronic kidney disease (CKD) [1, 3, 5]
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callMore From: International braz j urol : official journal of the Brazilian Society of Urology
Disclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
