Debunking the Myth of Bladder Defunctionalisation After Urinary Diversion in PUV Patients

To evaluate bladder outcomes of PUV patients managed with ablation vs. diversion.

We reviewed our institutional PUV database (2005-2024), matching patients 1:1 based on age and PURK (posterior urethral valves CKD risk) scores. Data were collected on initial surgical management, age at the closure of diversion, medication use, clean intermittent catheterization (CIC), continence, videourodynamics, voiding cystourethrograms (VCUG), renal ultrasound and uroflowmetry parameters. Bladder capacity was estimated by age using Koff's formula and characterized by ICCS parameters (low-capacity <65 %; large-capacity >150 % of estimated bladder capacity). End-filling pressure was classified according to the UMPIRE protocol (low/intermediate-risk, hostile bladder). Cases were appropriately censored to ensure equivalent follow-up.

We included 57 patients managed by diversion (61 % vesicostomies), matched to 57 patients with primary ablation. We found no difference in medication use, CIC, infections or continence between the groups. There was no significant difference in bladder capacity estimated with video-urodynamics, VCUG, ultrasound, or uroflowmetry based on ICCS criteria, and there were no differences in end-filling bladder pressures.

Concerns over bladder defunctionalisation may be unwarranted, and our data indicates that bladder dynamics in children managed with urinary diversions are not different from those who underwent valve ablation, findings that go against some of the dogmas surrounding diversion.