Myogenic bladder decompensation in boys with a history of posterior urethral valves is caused by secondary bladder neck obstruction?
- 17 June 2005
- journal article
- Published by Wiley in BJU International
- Vol. 96 (1), 140-143
- https://doi.org/10.1111/j.1464-410x.2005.05583.x
Abstract
To investigate whether myogenic bladder decompensation in patients treated for congenital posterior urethral valves (PUV, the most serious cause of infravesical obstruction in male neonates and infants) may be secondary to bladder neck obstruction, as despite prompt ablation of PUV these patients can have dysfunctional voiding during later childhood or adolescence, the so-called 'valve bladder syndrome'. The study comprised 18 boys (mean age 14 years, range 6.2-18.5) who had had successful transurethral ablation of PUV between 1982 and 1996, and had completed a follow-up which included serial assessment of serum creatinine, completion of a standard voiding diary, ultrasonography with measurement of urine before and after voiding, a urodynamic examination with simultaneous multichannel recording of pressure, volume and flow relationships during the filling and voiding phases, coupled with video-cystoscopy at least twice. The mean (range) follow-up was 9.3 (6-17) years. Urodynamic investigation showed myogenic failure with inadequate bladder emptying in 10 patients; five with myogenic failure also had unstable bladder contractions. On video-cystoscopy the posterior bladder neck lip appeared elevated in all patients but in those with myogenic failure it was strongly suggestive of hypertrophy, with evidence of obstruction. At the last follow-up one patient with myogenic failure who had had bladder neck incision and four others who were being treated with alpha-adrenergic antagonists had a significant reduction of their postvoid residual urine. Despite early valve ablation, a large proportion of boys treated for PUV have gradual detrusor decompensation, which may be caused by secondary bladder neck obstruction leading to obstructive voiding and finally detrusor failure. Surgical or pharmacological intervention to improve bladder neck obstruction may possibly avert this course, but further studies are needed to validate this hypothesis.Keywords
This publication has 35 references indexed in Scilit:
- Myogenic Failure in Posterior Urethral Valve Disease: Real or Imagined?Journal of Urology, 2002
- THE VALVE BLADDER SYNDROME:Journal of Urology, 2002
- THE VALVE BLADDER SYNDROME:Journal of Urology, 2001
- DETRUSOR HYPOCONTRACTILITY EVOLUTION IN BOYS WITH POSTERIOR URETHRAL VALVES DETECTED BY PRESSURE FLOW ANALYSISJournal of Urology, 2001
- DETRUSOR HYPOCONTRACTILITY EVOLUTION IN BOYS WITH POSTERIOR URETHRAL VALVES DETECTED BY PRESSURE FLOW ANALYSISJournal of Urology, 2001
- DOES NEONATAL PYELOURETEROSTOMY WORSEN BLADDER FUNCTION IN CHILDREN WITH POSTERIOR URETHRAL VALVES?Journal of Urology, 2000
- Bladder Dysfunction in Boys with Posterior Urethral Valves before and after PubertyJournal of Urology, 1996
- Posterior urethral valves in the British isles:A multicenter B.A.P.S. reviewJournal of Pediatric Surgery, 1983
- Urethral Valves1British Journal of Urology, 1973