Boys with bladder dysfunction may have posterior urethral valves - A simple framework to aid investigation

Bladder dysfunction (BD) is a common presenting complaint to paediatric urology outpatient clinics, accounting for up to 47% of referrals and affecting one in ten children of toilet training age. Boys with bladder dysfunction have been shown to have higher rates of posterior urethral valves (PUV) however when to consider cystourethroscopy in this group is unclear.

Our primary aim was to assess the likelihood of detecting PUV in a cohort of boys of toilet training age presenting to a paediatric urologist with symptoms of bladder dysfunction. Our secondary aim was to assess whether resection of PUV was associated with improved clinical outcome.

Retrospective review of male patients aged 4-16 (January 2007 to December 2023), referred to paediatric urologist in an Australian outpatient clinic with BD undergoing cystourethroscopy. Those with known renal tract or spinal pathology were excluded. Patients were divided into four groups according to their symptoms/investigation results. Patients were followed up to assess improvement in symptoms following resection of PUV.

247 boys were included in this study with a median age of 8.1 years. 81/247 (32.8%) had PUV on cystourethroscopy. The highest incidence of PUV 13/25 (52%) was in those patients with BD, haematuria or UTI and ultrasound (USS) changes. There was no difference in outcome improvement in those who underwent resection of PUV when compared with those without PUV.

Our study findings concur with results from previous literature identifying higher rates of PUV in older boys with bladder dysfunction. We have utilised straightforward clinical criteria to provide a targeted framework for screening with cystourethroscopy. There was no difference in outcomes when PUV was resected, compared to those without PUV. Limitations of this study include the retrospective nature, possible selection and reporting biases.

The likelihood of detecting PUV in our cohort of boys aged 4-16 with bladder dysfunction was 32.8%. The four groups provide clinicians with guidance on who may benefit from cystoscopy. This study provides future scope for a prospective interventional study of PUV in boys with BD.