Related Experiment Videos
Lower urinary tract changes after early valve ablation in neonates and infants: is early diversion warranted?
C E Close1, M C Carr, M W Burns
1Division of Pediatric Urology, Children's Hospital, Seattle, Washington, USA.
Insights
Early valve ablation in infants with posterior urethral valves improves bladder function and appearance. This treatment offers a better alternative to urinary diversion, which often fails to prevent renal decline and hinders bladder recovery.
Area of Science:
- Pediatric Urology
- Nephrology
- Pediatric Surgery
Background:
- Posterior urethral valves (PUV) in male infants often necessitate urinary tract diversion due to severe hydronephrosis, reflux, or renal insufficiency.
- While diversion can manage obstruction, it frequently leads to progressive renal function loss and bladder defunctionalization.
- Alternative early interventions aim to preserve or restore normal bladder function.
Purpose of the Study:
- To evaluate the efficacy of primary valve ablation in newborns with PUV compared to traditional urinary diversion.
- To assess the impact of early valve ablation on bladder recovery and renal function preservation.
- To determine if early intervention can prevent long-term renal insufficiency and improve bladder outcomes.
Main Methods:
- Retrospective review of infants treated for PUV within the first year of life.
- Comparison of outcomes between primary valve ablation (23 patients) and urinary diversion (8 patients).
- Voiding cystourethrograms were used to assess bladder abnormalities (trabeculation, bladder neck hypertrophy, prostatic urethral dilatation) pre- and post-operatively.
Main Results:
- Primary valve ablation led to significant improvement or resolution of bladder abnormalities by 1 year post-surgery.
- Patients undergoing primary valve ablation showed statistically better bladder compliance and volume compared to those with diversion.
- Urinary diversion failed to halt progressive renal failure in most cases, and primary valve ablation also did not consistently prevent renal decline.
Conclusions:
- Early valve ablation in infants with PUV promotes recovery of normal bladder appearance and function.
- Severe renal insufficiency often progresses despite upper tract diversion, which can also impede bladder recovery.
- Primary valve ablation in the newborn period is a promising approach for improving bladder outcomes in infants with PUV.
Purpose:
Severe hydronephrosis, high grade reflux and/or renal insufficiency often leads to proximal urinary tract diversion in male infants with posterior urethral valves. Even with this treatment progressive loss of renal function often occurs. Unfortunately with early diversion the bladder, already damaged by in utero obstruction, is also defunctionalized. Alternative treatment with valve ablation in the newborn period and without diversion may facilitate recovery of normal bladder function.
Materials And Methods:
We retrospectively reviewed the records of infants treated for posterior urethral valves before age 1 year at our institution in the last 8 years. Treatment comprised primary valve ablation in 23 patients and urinary diversion in 8. Preoperative and serial postoperative voiding cystourethrograms were scored for degree of trabeculation, bladder neck hypertrophy and prostatic urethral dilatation in all patients undergoing primary valve ablation. Recovery of bladder and renal function after primary valve ablation was compared to that of patients treated with urinary diversion.
Results:
All patients treated with primary valve ablation demonstrated marked improvement or resolution of bladder abnormalities on voiding cystourethrography by 1 year postoperatively. Bladder compliance and volume were statistically better than in patients treated with primary diversion. Upper tract diversion failed to halt progressive renal failure in 5 of the 6 patients who underwent diversion. Similarly primary valve ablation did not stop progressive renal failure in a matched group of patients.
Conclusions:
Early ablation of posterior urethral valves results in the recovery of normal bladder appearance and function when performed in the first months of life. Severe renal insufficiency tends to progress even with upper tract diversion. Furthermore, this treatment prevents normal bladder cycling, which may inhibit bladder recovery in the patient with posterior urethral valves.