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Urodynamic findings of posterior urethral valve patients
1Department of Pediatric Surgery, Istanbul University, Cerrahpaşa Medical Faculty, Istanbul, Turkey.
Insights
Posterior urethral valves (PUV) often cause bladder obstruction in children. Early treatment of PUV can improve bladder function, as indicated by urodynamic findings, especially in younger patients.
Area of Science:
- Pediatric Urology
- Pediatric Nephrology
- Urodynamics
Background:
- Posterior urethral valve (PUV) is the most common cause of bladder outlet obstruction in children.
- Long-term bladder function after PUV treatment requires further investigation.
Purpose of the Study:
- To analyze urodynamic findings in children after posterior urethral valve fulguration.
- To correlate urodynamic parameters with patient age and long-term outcomes.
Main Methods:
- Retrospective analysis of urodynamic data from 26 children treated for PUV.
- Assessment of bladder capacity, compliance, detrusor activity, and residual urine post-fulguration.
Main Results:
- Abnormal urodynamic findings were common, including decreased bladder capacity (15/26) and hypo-compliance (13/26).
- Younger children (<4 years) more frequently exhibited hypo-compliance and reduced bladder capacity.
- High residual urine was associated with chronic renal failure (6/8 patients).
- Bladder augmentation was required in 5 patients, all treated after 2.5 years of age, with 4 showing hypo-compliance and low capacity.
Conclusions:
- Children with PUV consistently demonstrate pathological urodynamic findings that evolve with age.
- Early relief of infravesical obstruction appears crucial for improving bladder function.
- Urodynamic studies are valuable for tailoring treatment strategies based on bladder function.
Abstract:
The most frequently observed cause of obstructed bladder in children is the posterior urethral valve (PUV). In this report, we analysed the urodynamic findings of 26 patients whose valves were fulgurated 12.6 months previously (range: 2 days - 8 years,after the fulguration). The mean age of the patients at the time of the procedure was 4.5 years (range: 2 months -13 years). Bladder capacity was decreased in 15, increased in 6, and normal in 5 patients; hypo-compliance was observed in 13, hyper-compliance was observed in 4, and normo-compliance was observed in 9 children. Generally, hypo-compliance and decreased bladder capacity was more frequent in patients younger than 4 years of age. There were 10 patients with instable detrusor contractions(IDC) and high residual urine was present in 8 patients. Eight patients developed chronic renal failure and 6 of these patients had high residual urine. All the patients who required bladder augmentation during follow-up were the ones treated after 2.5 years of age; 4 of these 5 patients had hypo-compliance and low bladder capacity on urodynamic studies. In conclusion, all patients with PUV had pathological urodynamic findings that could change with age, and early relief of the infravesical obstruction could have an improving effect on bladder function. Urodynamic investigations may help us to design the proper treatment according to the bladder function.