Evaluation and management of urinary incontinence after surgery for posterior urethral valves

Posterior urethral valves lead to an overlapping constellation of urodynamic abnormalities, often many years after the initial diagnosis and valve ablation. Voiding dysfunction and urinary incontinence in boys with a history of valves are seldom the result of sphincteric incompetence. Three major categories of bladder dysfunction may cause voiding symptoms: myogenic failure, detrusor hyperreflexia, and bladder hypertonia. The interaction of the severity and duration of valve obstruction may be important factors, but the determinants of ultimate bladder function in the setting of urethral valves remain unclear. A careful urodynamic assessment is needed to define the abnormal bladder and to select and evaluate therapy. Therapy should be designed to provide low-pressure urinary storage for a socially acceptable period of time as well as complete emptying of the bladder. Success may require several lines of treatment and demands patience, not only of the patient and his family, but of the physician.