Surgical treatment for children with posterior urethral valve

Abstract

Objective. To assess treatment outcomes in children with posterior urethral valve (PUV). Patients and methods. We analyzed treatment outcomes in 60 children with PUV within a non-randomized, retrospective, single-center, pilot study. Sixty patients have undergone PUV ablation; 8 of them required repeated ablation. Endoscopic treatment of vesicoureteral reflux (VUR) was performed in 31 ureters; 5 children had botulinum toxin therapy. Results. Type 1 PUV was diagnosed in 49 patients (81.6%), whereas type 3 PUV was identified in 11 patients (18.3%). VUR was detected in in 65 ureters (54.1%); obstructive ureterohydronephrosis was diagnosed in 40 ureters (33.3%). Ablation of the valve flaps improved lower urinary tract (LUT) urodynamics in 27 children. Thirty-three patients had valve bladder syndrome (VBS). Improvement of the upper urinary tract (UUT) condition was achieved in 54 cases. Fifteen children have undergone nephroureterectomy. There was a significant decrease in the activity of pyelonephritis in children after endoscopic ablation of the PUV. Fifty-three patients (88.3%) demonstrated severe UUT urodynamic disorders. The baseline grade of UUT lesions affected treatment outcome (p = 0.0009). Children with VBS symptoms had progressive UUT pathology and persistent urinary incontinence. Six patients eventually required replacement therapy. Conclusion. The majority of PUV children (88.3%) presented with severe UUT impairments. More than half of the patients (55.0%) had VBS symptoms. Their treatment should be comprehensive and include long-term monitoring of urodynamics and kidney function. Key words: posterior urethral valve, valve bladder syndrome, vesicoureteral reflux