Management of boys with posterior urethral valves (PUV): a world-wide survey

Posterior Urethral Valves (PUV) are a complex condition and evidence-based consensus on best management is lacking. Our objective was to determine current practice patterns and institutional infrastructure/resources.

A cross-sectional survey (REDCap) was distributed to colleagues with experience in managing PUV via meetings, societies' links and digital platforms. Fifty questions covering demographics, antenatal management, surgery type, and length of follow-up were included.

We received 280 responses from 55 countries (6 continents) between April-July 2023. Among the respondents, 185 were paediatric urologists and 71 paediatric surgeons with interest in urology. Almost half (42%) did not have a standard protocol for PUV management and only 20% run a dedicated multidisciplinary clinic. Almost 80% would support the elaboration of an international consensus guideline. Antenatal counselling was available in 83% of respondents' institutions, with antenatal intervention offered in 30%, mainly vesico-amniotic shunt insertion. Cold knife-ablation was the preferred treatment (60%), but with technical differences. One-third of the respondents rely on clinical assessment or ultrasound to confirm the success of ablation. Circumcision was not routinely offered by 25% of respondents, and 15% did not prescribe antibiotic prophylaxis. Few respondents universally started clean intermittent catheterisation (5%) and anticholinergics (19%) after birth. High-volume institutions were most likely to investigate bladder function, including bladder neck obstruction, although not necessarily with VUD and not in infancy.

Our results demonstrated high variability in management strategies and need for a more structured, standardised approach for children with PUV was stated by almost all respondents. The development of guidelines could be widely adopted and lead to improved quality of care.