Clinical considerations in adults with history of posterior urethral valves

Abstract

Management of patients with posterior urethral valves (PUV) is commonplace for many pediatric urologists, however adult providers may be far less familiar with this diagnosis, its management and long-term ramifications. As urologic management of these patients has evolved, clinical outcomes have substantially improved with many more patients now surviving into adulthood. These patients remain at increased risk of morbidity due to their condition and therefore are likely to benefit from long term follow-up with adult providers. In this review we analyze the psychosocial impacts of PUV on adults, evaluate long term transplant outcomes in PUV patients and discuss effective clinical management strategies of bladder dysfunction in adult PUV patients. A retrospective literature review was performed using the MEDLINE (Pubmed) electronic database using key words such as "posterior urethral valve", "quality of life", "sexual function", "transplant outcomes", "bladder dysfunction", "mitrofanoff" etc. to identify relevant studies. Generally, the quality of life of PUV patients is good, those suffering from renal insufficiency or lower urinary tract symptoms, specifically incontinence, appear to be a group that may benefit from more intensive follow-up. Good long-term kidney transplant (KT) function and survival can be achieved in patients with PUV. Rigorous management to optimize bladder function and close follow-up, are key for long term graft survival after KT. The chronicity of PUV warrants adult providers to be not only well versed in the pathophysiology of the disease, but well prepared to care for these patients as they transition into adulthood. Additional studies addressing psychosocial, clinical and transplant outcomes of adults with PUV are necessary to develop optimal long-term follow-up regimens for these patients.