Long-term bladder function, fertility and sexual function in patients with posterior urethral valves treated in infancy
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Published on: January 7, 2019
P López Pereira1, M Miguel, M J Martínez Urrutia
1Department of Paediatric Urology, University Hospital La Paz, Madrid, Spain. plpuro@hotmail.com
Insights
Most patients with posterior urethral valves (PUV) experience normal sexual function and fertility. However, long-term follow-up shows a significant risk of chronic kidney disease, though bladder issues are uncommon.
Area of Science:
- Urology
- Pediatric Surgery
- Nephrology
Background:
- Posterior urethral valves (PUV) are a common congenital anomaly in male infants.
- Long-term outcomes regarding renal function, bladder function, and sexual health in adult PUV survivors are not fully understood.
Purpose of the Study:
- To evaluate sexual function and fertility in adult patients previously treated for PUV.
- To assess the prevalence of voiding dysfunction symptoms in this cohort.
Main Methods:
- A questionnaire was sent to 47 adult patients (age > 18) treated for PUV in infancy; 28 were contactable.
- The questionnaire assessed voiding dysfunction, and sexual function including erection, orgasm, and ejaculation.
- Renal function was evaluated, and semen/urine samples were analyzed in a subset of patients.
Main Results:
- Of 16 respondents, most reported normal voiding frequency and no significant incontinence or overactivity symptoms.
- Sexual function was generally normal, with 4 reporting mild/moderate erectile dysfunction and 1 slow ejaculation.
- Renal function varied, with some patients showing reduced glomerular filtration rate or requiring renal transplant; semen analysis revealed abnormalities in some.
Conclusions:
- Adult PUV survivors infrequently experience bladder dysfunction.
- Sexual function is predominantly normal, with semen parameters generally compatible with paternity.
- A significant percentage of PUV patients develop chronic or end-stage renal disease long-term.
Objective:
To address the issue of sexual function and fertility in PUV patients.
Patients And Methods:
Of 47 patients (age > 18 years) treated for PUV in infancy 28 were contactable. They were sent a standard questionnaire requesting details on voiding dysfunction symptoms, and experience of erection, orgasm and ejaculation.
Results:
Of the 28, 16 (mean age 24 years) returned the questionnaire. Voiding frequency ranged from 3 to 10 times per day (mean = 5). Two patients had occasional mild diurnal incontinence but none had symptoms of overactivity. Three patients had a weak urinary stream. Renal function was normal in 9, 4 had a glomerular filtration rate <80 ml/min/1.73 m(2), and 3 had undergone renal transplant. Erections and orgasm were experienced by the 15 patients who responded to these questions, with 4 reporting mild or medium erectile dysfunction and 1, on dialysis, reporting slow ejaculation. Post-masturbation samples of semen and urine were collected from 6 patients. One had an alkaline pH, high percentage of immotile sperm and low sperm count. Another had a high concentration of abnormal forms, and seminal fluid was present in the urine of 3 patients.
Conclusions:
In long-term follow-up, 44% of PUV patients develop chronic renal failure or end-stage renal disease, but bladder dysfunction symptoms are infrequent. Sexual function is mostly normal. Total semen counts and motility are compatible with paternity in most patients.
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