[RESTORATION OF LOWER URINARY TRACT FUNCTION WITHOUT AUGMENTATION CYSTOPLASTY IN A BOY WITH SEVERE BLADDER DEFORMITY...

The disease severity of posterior urethral valve (PUV) ranges from life-threatening neonatal cases to milder forms diagnosed later in life because of urinary tract infection (UTI) or voiding dysfunction. Despite early intervention, predicting the prognosis of patients with PUV remains challenging, particularly regarding long-term bladder functional outcomes. Here, we present a case in which lower urinary tract function was restored without augmentation cystoplasty in a boy with PUV who presented with severe bladder deformity in infancy.A 10-month-old boy with a history of febrile UTI (fUTI) was referred to our hospital for evaluation of bilateral hydronephroureters. The patient's family and prenatal histories were unremarkable. Ultrasonography revealed bilateral hydronephroureters with bladder deformity. Voiding cystourethrography (VCUG) demonstrated dilation of the posterior urethra, elevated bladder neck, and massive right-sided vesicoureteral reflux (VUR). Urethroscopy confirmed a type 3 PUV, which was successfully incised endoscopically. After valve ablation, impaired bladder compliance was noted with no resolution of VUR on video-urodynamic study; therefore, oxybutynin therapy was initiated. Owing to persistent upper urinary tract dilation, vesicostomy was performed at 1 year and 9 months of age. Postoperatively, neither hydronephrosis nor UTI was observed. A repeat video-urodynamic study showed improved bladder compliance and resolution of VUR, leading to vesicostomy closure at 5 years and 10 months of age. At nine years of follow-up, the patient remained dry throughout the day without medication, recurrent fUTIs, or hydronephrosis.