Mitrofanoff for valve bladder syndrome: effect on urinary tract and renal function

Area of Science:

• Pediatric Urology
• Nephrology
• Surgical Innovation

Background:

• Posterior urethral valves (PUV) can lead to progressive renal impairment despite early intervention.
• Bladder dysfunction is a significant factor in the renal deterioration associated with PUV.
• Effective management strategies for bladder dysfunction in PUV are crucial for preserving renal function.

Purpose of the Study:

• To evaluate the efficacy of clean intermittent catheterization (CIC) and overnight drainage via a Mitrofanoff appendicovesicostomy in managing bladder dysfunction in boys with PUV.
• To assess the impact of this treatment on upper tract imaging, urodynamic parameters, and renal function.

Main Methods:

• A cohort of 24 boys with valve bladder syndrome underwent Mitrofanoff formation for CIC and overnight drainage.
• Treatment involved 3-4 daytime CIC sessions and overnight indwelling catheterization via the Mitrofanoff stoma.
• Outcomes were analyzed by tracking serum creatinine, renal ultrasound findings, and urodynamic data over a median follow-up of 6.2 years.

Main Results:

• Significant improvement in hydronephrosis was observed, with a mean reduction in renal pelvis anteroposterior diameter of 14.2 mm (p ≤ 0.001).
• Bladder compliance improved significantly (75% initially poor vs. 28.6% at follow-up, p = 0.014), although bladder capacity changes were not statistically significant.
• Despite improvements in upper tract and bladder parameters, mean estimated glomerular filtration rate (eGFR) declined, and 35% of patients progressed to end-stage renal failure.

Conclusions:

• Treatment with CIC and overnight drainage via a Mitrofanoff stoma effectively improves hydronephrosis and urodynamic parameters in boys with PUV.
• This therapeutic approach does not halt the progression of renal deterioration in this patient population.
• Long-term renal function monitoring and further research into renoprotective strategies are warranted for boys with PUV.