Related Experiment Video
Updated: May 22, 2025
Vessel-sparing Excision and Primary Anastomosis
Published on: January 7, 2019
Toilet training achievements in children born with posterior urethral valves
Irene Paraboschi1,2, Michela Marinaro2,3, Pankaj Mishra3
1Department of Biomedical and Clinical Science, University of Milan, Milano, Italy irene.paraboschi@hotmail.com massimo.garriboli@gstt.nhs.uk.
Insights
Boys with posterior urethral valves (PUV) can achieve continence, but cognitive comorbidities significantly delay toilet training success. Early intervention is crucial for managing bladder function in these children.
Area of Science:
- Pediatric Urology
- Developmental Pediatrics
- Continence Management
Background:
- Posterior urethral valves (PUV) obstruct the urethra during fetal development, often causing persistent bladder dysfunction.
- Detrusor overactivity and vesical overdistension are common sequelae despite early surgical correction.
- Successful toilet training is critical for managing bladder pressures and protecting upper urinary tract function.
Purpose of the Study:
- To evaluate toilet training outcomes in children with a history of PUV.
- To identify factors influencing the achievement of daytime and night-time continence.
Main Methods:
- A single-centre ambispective cohort study included 142 children (aged ≥4 years) who underwent PUV ablation.
- Patients were stratified into two groups: those with cognitive comorbidities (Group A) and those without (Group B).
- Cognitive comorbidities included autism spectrum disorder, ADHD, and Trisomy 21.
Main Results:
- 90.1% achieved daytime continence (median age 37 months) and 81.0% achieved night-time continence (median age 42 months).
- Children with cognitive comorbidities (Group A) had significantly lower continence rates (daytime 74.2%, night-time 67.7%) compared to Group B (daytime 94.6%, night-time 84.7%).
- Group A also experienced significant delays in achieving both daytime (median 64 months) and night-time continence (median 60 months) compared to Group B (daytime 36 months, night-time 42 months).
Conclusions:
- Boys with PUV can achieve daytime and night-time continence at ages comparable to the general population.
- The presence of cognitive comorbidities is strongly associated with delayed toilet training milestones in children with PUV.
- These findings underscore the importance of tailored management strategies for children with PUV and co-existing cognitive impairments.
Objective:
Boys born with posterior urethral valves (PUV) often experience bladder development issues due to urethral obstruction during gestation. Despite early surgical intervention, bladder dysfunction can persist, leading to detrusor overactivity and vesical overdistension. Successful toilet training is key in managing bladder function and controlling intravesical and upper urinary tract pressures. This study aims to evaluate toilet training outcomes in children with PUV.
Study Design:
This single-centre ambispective cohort study included 142 children aged 4 years and older who underwent PUV ablation between January 2003 and December 2021. The patients were categorised into two groups: those with cognitive comorbidities (group A), including autism spectrum disorder, attention deficit hyperactivity disorder and trisomy 21, and those without (group B).
Results:
Among the 142 children, 128 (90.1%) achieved daytime continence at a median age of 37 months (range 33-49 months) and 115 (81.0%) attained night-time continence at a median age of 42 months (range 34-60 months). Children in group A showed significantly lower rates of continence compared with group B (daytime: 74.2% vs 94.6%, p=0.0026; night-time: 67.7% vs 84.7%, p=0.0412). Additionally, children in group A completed toilet training significantly later than those in group B (daytime: 64 vs 36 months, p=0.0002; night-time: 60 vs 42 months, p=0.0139).
Conclusion:
Boys with PUV can achieve daytime and night-time continence at ages comparable to those reported by their peers; the presence of cognitive comorbidities is associated with delays in achieving these milestones.
