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Published on: January 7, 2019
Does treatment with clean intermittent catheterization in boys with posterior urethral valves affect bladder and
G Holmdahl1, U Sillen, A-L Hellström
1Department of Pediatric Surgery, Queens Children's Hospital, Göteburg, Sweden.
Insights
Treating bladder dysfunction in boys with posterior urethral valves (PUV) can improve renal function. Early intervention with clean intermittent catheterization (CIC) shows promising results in maintaining kidney health.
Area of Science:
- Pediatric Urology
- Nephrology
- Pediatric Surgery
Background:
- Posterior urethral valves (PUV) can lead to deteriorating renal function in childhood and adolescence.
- Bladder dysfunction is a significant contributing factor to renal impairment in boys with PUV.
Purpose of the Study:
- To evaluate the impact of treating bladder dysfunction on renal function in boys with PUV.
- To assess the long-term effects of clean intermittent catheterization (CIC) and bladder management on kidney health.
Main Methods:
- A cohort of 35 boys with PUV were managed with early toilet training and pharmacotherapy for incontinence.
- 19 boys with significant bladder dysfunction underwent clean intermittent catheterization (CIC) starting at a median age of 8 months.
- Renal function was assessed using glomerular filtration rate (GFR) at baseline and during follow-up.
Main Results:
- Boys undergoing CIC showed a significant increase in median GFR over time, similar to the non-CIC group.
- Discontinuation of CIC in two boys resulted in renal function deterioration.
- Bladder capacity increased in most boys treated with CIC, and detrusor instability decreased.
Conclusions:
- Treatment of bladder dysfunction, including CIC, can mitigate the decline in renal function in boys with PUV.
- Early and consistent management of bladder issues is crucial for preserving kidney function in this population.
- Further research with larger cohorts is warranted to confirm these findings.
Purpose:
In boys with resected posterior urethral valves (PUV) deterioration of renal function is seen during childhood and adolescence, which may partly be caused by bladder dysfunction. We present data on renal and bladder function initially and at followup of boys with PUV in whom the bladder dysfunction has been treated since infancy.
Materials And Methods:
The study included 35 boys with PUV. Bladder regimen, including early toilet training from the age of 1.5 years and detrusor relaxant drugs for the treatment of incontinence from ages 4 to 6 years, was introduced to all patients. A total of 19 boys were started on clean intermittent catheterization (CIC) at a median age of 8 months due to pronounced bladder dysfunction with poor emptying, unsafe pressure levels, high grade reflux and renal impairment.
Results:
No serious complications of CIC have been seen during followup. Of the 19 boys 2 stopped performing CIC due to noncompliance of the parents at 1 and 3 years, respectively. Initial renal function, measured as median glomerular filtration rate (GFR) in percent of expected for age, was 60% in the CIC group and 90% in the nonCIC group. At followup at a median age of 8 years the CIC group (n = 14, 3 transplanted boys excluded) had an increase in median differential GFR (difference between followup and initial GFR) of 7% (p <0.01), which was similar increase to that of the nonCIC group. In the 2 boys who stopped performing CIC renal function deteriorated with a median differential GFR of -24%. In the CIC group detrusor instability decreased. Poor compliance was seen in 6 of the 19 boys initially and only one remained poorly compliant. In 1 of the boys who stopped performing catheterization a low compliant bladder developed. In all of the other cases bladder capacity increased more than expected for age.
Conclusions:
The results suggest that treatment of bladder dysfunction in boys with PUV can counteract the deterioration in renal function seen during childhood but the number of patients in our study is limited.
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