The valve bladder syndrome: 20 years later

Area of Science:

• Pediatric Urology
• Nephrology
• Urodynamics

Background:

• Posterior urethral valves (PUV) can lead to a complex condition known as valve bladder syndrome.
• This syndrome includes findings like a noncompliant bladder, incontinence, and nephrogenic diabetes insipidus following valve ablation.

Purpose of the Study:

• To review the history and ongoing debate surrounding the valve bladder syndrome.
• To analyze 20 years of urodynamic and histological investigations into its etiology and management.

Main Methods:

• Comprehensive literature review of outcome studies, histological findings, animal models, and urodynamic investigations over the past 20 years.
• Comparison of reported data to assess the causes of bladder compliance loss.

Main Results:

• Loss of bladder compliance is common after valve ablation, contributing to upper tract dilatation and incontinence.
• In utero damage is likely the primary cause of severe compliance loss, rather than temporary urinary diversion.
• Many temporarily diverted cases demonstrate adequate or even superior bladder function compared to valve ablation alone.

Conclusions:

• Valve ablation without urodynamic follow-up is insufficient; proactive management is essential.
• Temporary diversion does not typically cause a fibrotic, noncompliant bladder.
• Anticholinergic therapy and urodynamics can often manage valve bladder syndrome effectively, potentially avoiding undiversion surgery.