Bladder Function Associated With Posterior Urethral Valves After Primary Valve Ablation or Proximal Urinary Diversion in Children and Adolescents

Abstract

No AccessJournal of UrologyPosterior Urethral Valves1 Oct 2002Bladder Function Associated With Posterior Urethral Valves After Primary Valve Ablation or Proximal Urinary Diversion in Children and Adolescents M. Podestá, A.C. Ruarte, C. Gargiulo, R. Medel, R. Castera, and M. Herrera M. PodestáM. Podestá More articles by this author , A.C. RuarteA.C. Ruarte More articles by this author , C. GargiuloC. Gargiulo More articles by this author , R. MedelR. Medel More articles by this author , R. CasteraR. Castera More articles by this author , and M. HerreraM. Herrera More articles by this author View All Author Informationhttps://doi.org/10.1016/S0022-5347(05)64424-2AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract Purpose: We retrospectively reviewed 2 series of patients with posterior urethral valves treated initially with valve ablation preceded by bilateral cutaneous ureterostomies or valve ablation alone to evaluate and compare bladder function behavior of each treatment group. Materials and Methods: From 1970 to 1983, 19 males 22 days to 21 months old with posterior urethral valves were treated with 1 of 2 initial surgical approaches, including upper tract diversion, delayed undiversion and ablation in 11 (group 1), and primary valve ablation only in 8 (group 2). Median patient age at the time of cutaneous urinary diversion and primary valve ablation for groups 1 and 2 was 7 and 9 months, respectively. Median duration of bladder defunctionalization was 48 months. All patients were evaluated urodynamically after initial ablation or re-functionalization of the bladder using standard rapid fill cystometry. Median patient age for groups 1 and 2 was 14 and 9.5 years, respectively, at the time of urodynamic testing 16 and 12.6 years, respectively, at followup. Results: Urodynamic assessment revealed detrusor instability in 5 group 1 patients but in only group 2 1 patient. Group 2 patients had significantly lower median end filling pressure (4 versus 15 cm. water, p <0.03) and higher maximum bladder capacity (1.4 versus 0.8, p <0.005) than those in group 1. Group 1 patients had lower compliance than those in group 2 (median 15 versus 82 cm. water, p <0.05). Further analysis showed no difference between groups 1 and 2 in overall median voiding detrusor pressure at maximum flow (51 versus 52.6 cm. water, respectively). Cystometric detrusor under activity patterns were noted in 5 group 1 and 2 group 2 patients. Residual urine volumes were 17%, 31%, 19% and 8% of bladder capacity, respectively, in 2 group 1 and 2 group 2 patients. At final followup 5 group 1 and 2 group 2 patients had renal function deterioration. Two other group 1 patients and group 2 had progression to end stage renal failure. A higher ureteral reimplantation rate was noted in group 1 (63%) than group 2 (6%). Conclusions: This retrospective study revealed that long-term bladder function of patients with posterior urethral valves treated with temporary supravesical diversion is affected more adversely than those treated with valve ablation alone. References 1 : Posterior urethral valves in boys. A broad clinical spectrum. J Urol1971; 106: 298. Link, Google Scholar 2 : Growth in boys with posterior urethral valves. Urol Clin North Am1980; 7: 265. 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Crossref, Medline, Google Scholar From the Urology Unit, Department of Surgery, Hospital de Niños Ricardo Gutiérrez, Associated with the University of Buenos Aires, Argentina© 2002 by American Urological Association, Inc.FiguresReferencesRelatedDetailsCited byWu C, Traore E, Patil D, Blum E, Cerwinka W, Elmore J, Kirsch A, Scherz H and Smith E (2021) Role of a Preoperative Catheter Regimen in Achieving Early Primary Endoscopic Valve Ablation in Neonates with Posterior Urethral ValvesJournal of Urology, VOL. 205, NO. 6, (1792-1797), Online publication date: 1-Jun-2021.Jalkanen J, Heikkilä J, Kyrklund K and Taskinen S (2016) Controlled Outcomes for Achievement of Urinary Continence among Boys Treated for Posterior Urethral ValvesJournal of Urology, VOL. 196, NO. 1, (213-218), Online publication date: 1-Jul-2016.Fine M, Smith K, Shrivastava D, Cook M and Shukla A (2011) Posterior Urethral Valve Treatments and Outcomes in Children Receiving Kidney TransplantsJournal of Urology, VOL. 185, NO. 6S, (2507-2511), Online publication date: 1-Jun-2011.Soliman S (2009) Primary Ablation of Posterior Urethral Valves in Low Birth Weight Neonates by a Visually Guided Fogarty Embolectomy CatheterJournal of Urology, VOL. 181, NO. 5, (2284-2290), Online publication date: 1-May-2009.GHANEM M and NIJMAN R (2018) LONG-TERM FOLLOWUP OF BILATERAL HIGH (SOBER) URINARY DIVERSION IN PATIENTS WITH POSTERIOR URETHRAL VALVES AND ITS EFFECT ON BLADDER FUNCTIONJournal of Urology, VOL. 173, NO. 5, (1721-1724), Online publication date: 1-May-2005. Volume 168Issue 4 Part 2October 2002Page: 1830-1835 Advertisement Copyright & Permissions© 2002 by American Urological Association, Inc.KeywordsbladderurethraurodynamicsMetricsAuthor Information M. Podestá More articles by this author A.C. Ruarte More articles by this author C. Gargiulo More articles by this author R. Medel More articles by this author R. Castera More articles by this author M. Herrera More articles by this author Expand All Advertisement PDF downloadLoading ...