The Effects of Bladder Neck Incision on Urodynamic Abnormalities of Children With Posterior Urethral Valves

Abstract

We evaluated the effects of simultaneous bladder neck incision and valve ablation on urodynamic abnormalities in patients with posterior urethral valves. A total of 46 patients with posterior urethral valves entered our prospective study between 1998 and 2003. Group 1 consisted of 22 patients who underwent simultaneous valve ablation and bladder neck incision at the 6 o'clock position. Group 2 consisted of 24 age matched patients with comparable prognostic factors who underwent simple valve ablation. Trends in renal function tests, urodynamics and changes in the upper urinary tracts were evaluated throughout followup. Mean patient age at presentation was 1.6 years in group 1 and 1.8 years in group 2. Preoperatively, all patients in both groups had hypercontractile bladders and comparable high maximum voiding detrusor pressures. At the end of followup (mean 4.5 years) no patient in group 1 had bladder hypercontractility or detrusor overactivity, and the mean maximum voiding detrusor pressure was 53 +/- 15 cm H(2)O. In comparison, 9 patients in group 2 had bladder hypercontractility, 6 had detrusor overactivity and the mean maximum voiding detrusor pressure was 87 +/- 45 cm H(2)O (p <0.01). Myogenic bladder failure developed in 5 patients in group 2. The number of patients requiring anticholinergic medication and the duration of treatment were also significantly higher in group 2 compared to group 1. Valve ablation with bladder neck incision may result in better bladder urodynamic function in comparison to simple valve ablation. However, long-term studies with followup through puberty are required to evaluate the final effects on renal function.