Results of Prospective Clinical Trial Comparing Concurrent Valve Ablation/Bladder Neck Incision (BNI) with Simple Valve Ablation in Children with Posterior Urethral Valve (PUV)

Abstract

Purpose To evaluate whether BNI along with PUV ablation can improve the final outcome. Patients and methods From 1998 to 2003, 46 PUV patients entered our prospective clinical trial. In group 1, 22 patients underwent simultaneous valve ablation and BNI (at 6 o'clock position). In group 2, 24 age-matched patients with comparable risk factors underwent simple valve ablation. Trends of renal function tests, urodynamics, and changes in the upper urinary tracts were evaluated throughout the follow-up. Results The mean age of patients at presentation was 1.6 and 1.8 years in group 1 and 2, respectively. The mean (range) duration of follow-up in both groups was 4.5 (2 to 7) years. Preoperatively, all patients had hypercontractile bladders and comparable high Pdetmax in both groups. Six months after procedure, mean Pdetmax, number of patients with bladder hypercontractility, and detrusor instability were significantly lower in group 1 versus 2. At the end of our follow-up, in group 1 no patient had bladder hypercontractility or detrusor instability and mean Pdetmax was 53 ± 15 cmH2O; whereas in group 2, 9 patients had bladder hypercontractility, 6 had detrusor instability, and mean Pdetmax was 87 ± 45 cmH2O (P Conclusions Combination of BNI and PUV ablation confers better bladder and renal function outcomes compared with simple valve ablation. Our findings propose bladder neck discoordination as an imperative part of PUV pathophysiology. The modified BNI technique seems to minimize the possibility of future retrograde ejaculation.