Management of Posterior Urethral Valves on the Basis of Urodynamic Findings
1997; Lippincott Williams & Wilkins; Volume: 158; Issue: 3 Linguagem: Inglês
10.1016/s0022-5347(01)64377-5
ISSN1527-3792
AutoresYoung H. Kim, Mark Horowitz, Andrew J. Combs, Victor W. Νitti, Joseph G. Borer, Kenneth I. Glassberg,
Tópico(s)Pediatric Urology and Nephrology Studies
ResumoNo AccessJournal of UrologyPosterior Urethral Valves1 Sep 1997Management of Posterior Urethral Valves on the Basis of Urodynamic Findings Young H. Kim, Mark Horowitz, Andrew J. Combs, Victor W. Nitti, Joseph Borer, and Kenneth I. Glassberg Young H. KimYoung H. Kim , Mark HorowitzMark Horowitz , Andrew J. CombsAndrew J. Combs , Victor W. NittiVictor W. Nitti , Joseph BorerJoseph Borer , and Kenneth I. GlassbergKenneth I. Glassberg View All Author Informationhttps://doi.org/10.1016/S0022-5347(01)64377-5AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract Purpose: Abnormal urodynamic findings are common in boys with a history of posterior urethral valves. However, to our knowledge there are few reports on the results of treating these abnormal findings. We analyzed the treatment of abnormal urodynamic parameters and its outcome in 21 boys who underwent valve ablation. Materials and Methods: After valve ablation multichannel urodynamic studies were performed in 31 boys, including 21 in whom studies were done before and after therapy was started for abnormal parameters. Detrusor instability and impaired bladder compliance were treated with anticholinergics or augmentation cystoplasty, and impaired detrusor contractility was managed with clean intermittent catheterization. Results: Before therapy 17 of 21 boys had impaired compliance and detrusor instability, 2 had impaired compliance without instability and 2 had instability alone. After treatment 8 boys had impaired compliance and 4 had detrusor instability. After anticholinergics were initiated new onset myogenic failure in 2 boys necessitated clean intermittent catheterization. Of the 13 patients who presented with urinary incontinence 10 became dry and 3 had improvement with therapy. Vesicoureteral reflux in 10 boys at the time of the initial urodynamic study resolved in 7 with anticholinergic medication and in 1 after clean intermittent catheterization was begun for severely impaired compliance. All 21 boys were treated with anticholinergics and 2 were ultimately treated with augmentation cystoplasty. Clean intermittent catheterization was also instituted in 5 patients, including the 2 who required clean intermittent catheterization after myogenic failure developed. Five boys with high voiding pressures were found to have outlet obstruction due to residual valve tissue in 2, bladder neck obstruction in 2 and urethral stricture in 1 despite normal flow rates in 2. Conclusions: Urodynamic studies are helpful in guiding therapy in boys after valve ablation. Anticholinergic therapy can improve compliance, decrease detrusor instability, improve continence and eliminate vesicoureteral reflux in the majority of boys, although there is an associated risk of myogenic failure. Flow rates and fluoroscopic voiding studies are often unable to detect outlet obstruction and must be obtained in conjunction with voiding pressure measurements to make this diagnosis. References 1 Glassberg, K. I., Schneider, M. and Waterhouse, K.: Observations of the dilated ureter following posterior urethral valve resection. Read at annual meeting of the American Urological Association, New York, New York, May 13, 1979. Google Scholar 2 : Observations on persistently dilated ureter after posterior urethral valve ablation.. Urology1982; 20: 20. Google Scholar 3 : Current issues regarding posterior urethral valves.. Urol. Clin. N. Amer.1985; 12: 175. Google Scholar 4 : The bladder in boys with posterior urethral valves: a urodynamic assessment.. J. Urol.1979; 121: 769. Abstract, Google Scholar 5 : The urodynamic consequences of posterior urethral valves.. J. Urol.1990; 144: 122. Abstract, Google Scholar 6 : Valve bladder syndrome.. Read at meeting of the North Central Section. Hamilton, Bermuda: American Urological Association1980. Google Scholar 7 : The flow rate nomogram: I.. Development. J. Urol.1979; 122: 665. Abstract, Google Scholar 8 : Estimating bladder capacity in children.. Urology1983; 21: 248. Google Scholar 9 : Comparative urodynamic findings after primary valve ablation, vesicostomy or proximal diversion.. J. Urol.1996; 156: 673. Abstract, Google Scholar 10 : Cutaneous vesicostomy effect on bladder's eventual function.. Dial. Ped. Urol.1990; 13: 4. Google Scholar 11 : Long-term status of patients with posterior urethral valves.. Urol. Clin. N. Amer.1990; 17: 373. Google Scholar 12 : Long-term outcome of boys with posterior urethral valves.. Brit. J. Urol.1988; 62: 59. Google Scholar 13 : Posterior urethral valve obstruction.. AUA Update Series1992; vol. XI: 226. lesson 29. Google Scholar 14 : Major and minor complications of posterior urethral valves.. J. Urol.1981; 126: 517. Abstract, Google Scholar 15 : Augmentation cystoplasty in boys with posterior urethral valves.. J. Urol.1995; 154: 874. Abstract, Google Scholar 16 : Early ureteral surgery for posterior urethral valves.. Urol. Clin. N. Amer.1990; 17: 361. Google Scholar 17 : Persistent ureteral dilatation following valve resection.. Dial. Ped. Urol.1982; 5: 4. Google Scholar 18 : Persistent ureteral dilatation following valve resection.. Dial. Ped. Urol.1982; 5: 8. Google Scholar 19 : Upper urinary tract diversion for the most severe cases of posterior urethral valves.. In: Controversies in Urology.. Edited by . Chicago: Year Book Medical Publishers1989: 4. Google Scholar 20 : Alternatives in the management of posterior urethral valves.. Urol. Clin. N. Amer.1990; 17: 335. Google Scholar 21 : The outcome of renal transplantation in children with posterior urethral valves.. J. Urol.1988; 140: 1491. Link, Google Scholar 22 : Results of renal transplantation in boys treated for posterior urethral valves.. J. Urol.1993; 149: 1517. Abstract, Google Scholar 23 Woodhouse, C. R. J.: Personal communication, April, 1997. Google Scholar 24 : Bladder dysfunction in boys with posterior urethral valves before and after puberty.. J. Urol.1996; 155: 694. Abstract, Google Scholar 25 : Non-compliant bladder resulting from posterior urethral valves.. J. Urol.1985; 134: 708. Abstract, Google Scholar 26 : The changing urodynamic pattern in valve bladders during infancy.. J. Urol.1995; 153: 463. Abstract, Google Scholar 27 : Posterior urethral valves, unilateral reflux and renal dysplasia. A syndrome.. J. Urol.1982; 128: 994. Abstract, Google Scholar 28 : Vesicoureteric reflux with urethral valves.. Brit. J. Urol.1979; 51: 100. Google Scholar From the Department of Pediatric Urology, State University of New York Health Science Center at Brooklyn, Brooklyn, New York.© 1997 by American Urological Association, Inc.FiguresReferencesRelatedDetailsCited byAbdelhalim A, El-Hefnawy A, Dawaba M, Bazeed M and Hafez A (2019) Effect of Early Oxybutynin Treatment on Posterior Urethral Valve Outcomes in Infants: A Randomized Controlled TrialJournal of Urology, VOL. 203, NO. 4, (826-831), Online publication date: 1-Apr-2020.Glassberg K and Combs A (2016) The Valve Bladder Syndrome: 35+ Years LaterJournal of Urology, VOL. 196, NO. 1, (16-17), Online publication date: 1-Jul-2016.Casey J, Hagerty J, Maizels M, Chaviano A, Yerkes E, Lindgren B, Kaplan W, Meyer T and Cheng E (2012) Early Administration of Oxybutynin Improves Bladder Function and Clinical Outcomes in Newborns with Posterior Urethral ValvesJournal of Urology, VOL. 188, NO. 4S, (1516-1520), Online publication date: 1-Oct-2012.DONOHOE J, WEINSTEIN R, COMBS A, MISSERI R, HOROWITZ M, SCHULSINGER D and GLASSBERG K (2018) WHEN CAN PERSISTENT HYDROURETERONEPHROSIS IN POSTERIOR URETHRAL VALVE DISEASE BE CONSIDERED RESIDUAL STRETCHING?Journal of Urology, VOL. 172, NO. 2, (706-711), Online publication date: 1-Aug-2004.Misseri R, Combs A, Horowitz M, Donohoe J and Glassberg K (2018) Myogenic Failure in Posterior Urethral Valve Disease: Real or Imagined?Journal of Urology, VOL. 168, NO. 4 Part 2, (1844-1848), Online publication date: 1-Oct-2002.Glassberg K (2018) EDITORIAL: THE VALVE BLADDER SYNDROMEJournal of Urology, VOL. 167, NO. 1, (298-299), Online publication date: 1-Jan-2002.GLASSBERG K (2018) THE VALVE BLADDER SYNDROME: 20 YEARS LATERJournal of Urology, VOL. 166, NO. 4, (1406-1414), Online publication date: 1-Oct-2001. Volume 158Issue 3September 1997Page: 1011-1016 Advertisement Copyright & Permissions© 1997 by American Urological Association, Inc.MetricsAuthor Information Young H. Kim More articles by this author Mark Horowitz More articles by this author Andrew J. Combs More articles by this author Victor W. Nitti More articles by this author Joseph Borer More articles by this author Kenneth I. Glassberg More articles by this author Expand All Advertisement PDF downloadLoading ...
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