Outcome of Vesicostomy V/S Primary Ablation for Posterior Urethral Valves

Abstract

Purpose A vesicostomy is believed to have a detrimental effect in boys with posterior urethral valves compared to primary valve ablation. We compared the outcomes of boys managed by initial vesicostomy with those undergoing primary fulguration over a 15 year period. Material and methods The outcomes of 54 boys (23 vesicostomy, 31 primary valve fulguration) over 1 year of age who had not undergone renal transplant were considered. Outcome parameters identified were ultrasound findings, continence status, GFR and 1 year creatinine. Dryness was defined as completely dry both day and night with no need to wear pads. Results are presented with 95% confidence intervals. Results Ultrasound examinations were normal in 9/19 (47.4%) of the vesicostomy group and 11/24 (45.8%) of the fulguration group. Graded ultrasound results were not significantly different (p = 0.24). The vesicostomy patients were more often dry (79% vs 64%, p = 0.43). The vesicostomy group had on average higher GFR (95.26 vs 85.79) and lower 1 year creatinine values (49.58 vs 52.46). After accounting for age differences between groups, there was no significant difference in the GFR and 1 year creatinine values (p = 0.16 and p = 0.87 respectively). Conclusions There were no significant differences in the major outcomes between those children who were treated by initial vesicostomy and those who underwent primary fulguration.Vesicostomy may therefore be considered in selected cases of posterior urethral valves as the primary treatment option.