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Urodynamic profile in posterior urethral valve patients following fulguration: Does age at fulguration matter?
Ashwin Mallya1, Vilvapathy Senguttuvan Karthikeyan1, Sundaramoorthy Vijayganapathy1
1Department of Urology, Institute of Nephro Urology, Bengaluru, Karnataka, India.
Insights
Children with posterior urethral valve (PUV) who underwent valve fulguration (VF) at a younger age (<2 years) showed better bladder function. Longer time since VF also correlated with increased urinary bladder dysfunction in PUV patients.
Area of Science:
- Pediatric Urology
- Urodynamics
- Bladder Dysfunction
Background:
- Posterior urethral valve (PUV) can lead to urinary bladder (UB) dysfunction post-valve fulguration (VF).
- Urodynamics (UDS) is crucial for assessing UB function in these children.
Purpose of the Study:
- To investigate the impact of age at VF and time elapsed since VF on UB dysfunction in PUV patients.
- To identify risk factors for persistent or developing bladder issues after PUV treatment.
Main Methods:
- Retrospective analysis of 39 PUV patients undergoing UDS between 2009-2016.
- Patients were grouped by age at VF (<2 years vs. ≥2 years) and time since VF (≤4 years vs. >4 years).
Main Results:
- Reduced bladder compliance was observed in 67% of patients, with detrusor overactivity in 38.5% and 15.4% experiencing leaks.
- Younger age at VF (<2 years) was associated with better urodynamic profiles.
- Increased time since VF correlated with a higher incidence of bladder dysfunction.
Conclusions:
- Early valve fulguration (<2 years) in PUV patients is linked to improved long-term bladder function.
- The duration of time after valve fulguration is a significant factor in the development of urinary bladder dysfunction.
Introduction:
Children with posterior urethral valve (PUV) may develop urinary bladder (UB) dysfunction even after valve fulguration (VF). Using Urodynamics (UDS), we sought to identify whether age at VF and time elapsed since VF contributed to UB dysfunction.
Materials And Methods:
Between January 2009 and July 2016, 39 PUV patients referred to a tertiary care center for UDS were classified into Groups A and B (based on age if <2 or ≥2 years at VF) and subclassified into Group A1/A2 and B1/B2 depending on time duration after VF (TVU). A1 and B1 constituted TVU ≤4 years and A2 and B2 constituted TVU >4 years, respectively.
Results:
Median (range) ages at VF and UDS were 18 (1-108) months and 9 (1-19) years. Median (range) time between VF and UDS was 60 (6-164) months. Reduced compliance was seen in 67%, detrusor overactivity in 38.5%, and leak in 15.4% boys, respectively. Median (range) Qmax was 8 (0-28) ml/s and 25% boys had hypocontractile detrusor at voiding. Statistically significant reduction was found in compliance when comparing Group B versus Group A (P = 0.037) and in bladder capacity (P = 0.002) and compliance (P = 0.043) in Group A2 versus A1.
Conclusions:
Boys with VF at <2 years had better urodynamic profiles than those with fulguration over 2 years of age. As the time period since fulguration increased, there was a higher incidence of bladder dysfunction in both the groups.
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