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Can Concomitant Bladder Neck Incision and Primary Valve Ablation Reduce Early Re-admission Rate and Secondary

Ahmed Abdelhalim1, Abdelwahab Hashem1,2,3, Ebrahim E Abouelenein1

  • 1Department of Pediatric Urology, Urology and Nephrology Center, Mansoura University, Mansoura, Egypt.

International Braz J Urol : Official Journal of the Brazilian Society of Urology
|February 16, 2022
PubMed

Insights

Bladder neck incision (BNI) during posterior urethral valve ablation (PVA) does not lower early reintervention rates in infants with high bladder necks. This study found no significant difference in reintervention rates among different surgical approaches for posterior urethral valve (PUV).

Area of Science:

  • Pediatric Urology
  • Surgical Innovation
  • Congenital Anomalies

Background:

  • Posterior urethral valve (PUV) is a common cause of bladder outlet obstruction in male infants.
  • Management of PUV often involves ablation (PVA), but reintervention rates can be high, particularly with associated bladder neck abnormalities.
  • The role of bladder neck incision (BNI) in conjunction with PVA for high bladder neck morphology in PUV patients remains debated.

Purpose of the Study:

  • To evaluate the impact of bladder neck morphology and the addition of bladder neck incision (BNI) to posterior urethral valve ablation (PVA) on the early reintervention rate.
  • To compare reintervention rates in infants with PUV undergoing PVA with different bladder neck management strategies.

Main Methods:

  • A retrospective study of 114 infants undergoing PVA before 24 months of age with at least 18 months follow-up.
  • Patients were categorized into three groups: normal bladder neck (PVA only), high bladder neck (PVA + BNI), and high bladder neck (PVA only).
  • Early reintervention was defined as interventions within six months post-PVA due to persistent renal deterioration, worsening hydronephrosis, or unsatisfactory VCUG improvement.

Main Results:

  • No significant differences were observed in the overall re-admission (p=0.65) or re-intervention (p=0.50) rates among the three groups.
  • Specific reintervention rates were: Group 1 (normal bladder neck): 15.7%, Group 2 (high bladder neck + BNI): 14.3%, and Group 3 (high bladder neck only): 13.0%.
  • The addition of BNI to PVA in patients with high bladder neck morphology did not statistically reduce the need for early reintervention.

Conclusions:

  • Concomitant bladder neck incision (BNI) with posterior urethral valve ablation (PVA) does not decrease the early reintervention rate in patients with a morphologically high bladder neck.
  • The current findings suggest that surgical strategy for the bladder neck in PUV patients may not significantly impact early reintervention outcomes.
  • Further research may be warranted to explore other factors influencing reintervention rates in PUV management.
Abstract

Keywords:
Ablation TechniquesUrinary Bladder Neck ObstructionUrinary Bladder, Neurogenic

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