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[Bladder accommodation disorders in children with posterior urethral valves].
Journal D'Urologie
|January 1, 1983
Summary
Bladder dysfunction, not residual obstruction, often causes upper urinary tract dilation after posterior urethral valve treatment. Identifying this secondary bladder pathology prevents unnecessary interventions.
Area of Science:
- Pediatric Urology
- Urodynamics
- Endourology
Background:
- Posterior urethral valves (PUV) are a common cause of bladder outlet obstruction in infants.
- Endoscopic valve ablation is the standard treatment for PUV.
- Residual upper tract dilatation after PUV treatment can be challenging to manage.
Observation:
- This study examines 8 cases of persistent upper urinary tract dilatation post-PUV treatment.
- A key observation is the role of intrinsic bladder pathology, specifically impaired bladder accommodation with hypertonicity during filling.
- This secondary bladder dysfunction is termed a 'second bladder disease' residual after valve ablation.
Findings:
- Diagnosis of impaired bladder accommodation can be made by observing upper tract narrowing with a continuously drained bladder (no vesicoureteral reflux) and urodynamic confirmation of no residual cervico-urethral obstruction.
- Urography (comparing full and empty bladder states) alongside urodynamics is sufficient for diagnosis.
- This approach helps avoid misdiagnosis of primary ureteral or residual urethral obstruction.
Implications:
- Accurate diagnosis prevents unnecessary and potentially harmful procedures like ureterovesical reimplantation or further endoscopic interventions.
- Recognizing secondary bladder pathology is crucial for appropriate management strategies.
- Further research is needed to define the roles of urinary bypass and enterocystoplasty in managing these complex cases.