Related Experiment Videos
[The long-term behavior of the valve bladder as a function of the initial treatment and its effect on early kidney
P López1, N Leal, M J Martínez
1Departamento de Cirugía Pediátrica, Hospital Infantil La Paz, Madrid.
Insights
Posterior urethral valves (PUV) often lead to renal insufficiency. Bladder dysfunction and surgical mismanagement contribute to early renal failure in children with PUV, not the initial treatment method.
Area of Science:
- Pediatric Urology
- Nephrology
- Pediatric Surgery
Background:
- Posterior urethral valves (PUV) affect 25-40% of infants, potentially causing renal insufficiency before adolescence.
- Renal dysplasia, bladder dysfunction, and mismanagement can accelerate renal failure in these patients.
Purpose of the Study:
- To compare long-term bladder dysfunction rates in children treated with early temporary pyelostomy versus valve ablation for severe PUV.
- To investigate the role of bladder dysfunction and mismanagement in early-onset renal failure.
Main Methods:
- Urodynamic studies were conducted on 59 boys with severe PUV, divided into valve ablation (30) and cutaneous pyeloureterostomy (29) groups.
- Patients were assessed for bladder behavior, including instability, low compliance, and myogenic failure.
Main Results:
- 58% of boys exhibited bladder dysfunction (37% instability, 15% low compliance, 5% myogenic failure).
- Low compliance and myogenic failure were strongly associated with chronic renal failure (CRF).
- No significant difference in bladder function was observed between early diversion and valve ablation groups.
Conclusions:
- Neonatal pyeloureterostomy does not worsen long-term bladder dysfunction compared to valve ablation.
- Bladder dysfunction and surgical mismanagement are significant contributors to early renal failure in severe PUV cases.
- A substantial percentage of boys with severe PUV develop bladder dysfunction, highlighting the need for careful management.
Abstract:
In approximately 25-40% of infants presenting with posterior urethral valves (PUV) renal insufficiency will develop before adolescence. In some these patients, renal dysplasia, bladder dysfunction and mismanagement may precipitate renal failure at even earlier age. The goals of this study were to determine whether long-term bladder dysfunction was more frequent in children who underwent early temporary pyelostomy than in those who underwent valve ablation, and to know if bladder dysfunction and mismanagement, in some patients, could be responsible of early renal failure. Urodynamic studies were performed in 59 boys with severe PUV divided into two groups based on initial treatment. A) Valve ablation (30 p.); B) Cutaneous pyeloureterostomy (29 p.). At the end of the study 22 boys had chronic renal failure. Of the 59 boys, 42% (25 p.) had bladders with overdistended or normal behaviour, 58% (34 p.) had bladder dysfunction (instability 37%, low compliance 15%, myogenic failure 5%). The 89% of low compliance bladders, 66% of myogenic failure and 23% of those with instability were in CRF. No difference at all was found in bladder function between boys treated as neonates by high diversion or valve ablation. Of the group in chronic renal failure (22 p.), only 7 patients (32%) had bladders with normal behaviour and in five of these patients a mismanagement was directly related with a quicker renal deterioration. The 58% of our boys with severe PUV have some type of bladder dysfunction. Neonatal pyelo-ureterostomy does not increase long-term bladder dysfunction. Surgical mismanagement should be added to bladder dysfunction as contributors to earlier renal failure.