Can concomitant bladder neck incision and primary valve ablation reduce early re-admission rate and secondary intervention?

Abstract

Objective: To assess the effect of bladder neck morphology and its incision (BNI) in patients with posterior urethral valve (PUV) on early reintervention rate. Patients and methods: Infants undergoing PUV ablation (PVA) before 24 months of age and had at least 18 months of follow-up, were categorized into three groups according to the bladder neck appearance on baseline radiological and endoscopic examination: group 1; normal bladder neck underwent PVA, group 2; high bladder neck underwent PVA plus BNI, group 3; high bladder neck underwent PVA only. Early reintervention was defi ned as the need for check cystoscopy because of persistent renal function deterioration, worsening hydronephrosis and/or unsatisfactory VCUG improvement during the 1st six months post primary PVA. Results: Between 2000 and 2017, a total of 114 patients underwent PVA and met the study criteria with a median follow-up of 58 (18-230) months. For group 1, 16 (22.9%) patients needed readmission. Check cystoscopy was free and no further intervention was performed in 5(7.5%) and re-ablation was performed in 11(15.7%) patients. For group 2, 3(14.3%) patients needed reintervention. Re-ablation and re-ablation plus BNI were performed in 1(4.8%) and 2(9.5%), respectively. For group 3, cystoscopy was free in 1(4.3%), re-ablation and re-ablation plus BNI were performed 2(8.7%) and 1(4.3%), respectively. There were no signifi cant differences in the re-admission and re-intervention rates among the three study groups (p=0.65 and p=0.50, respectively). Conclusion: In morphologically high bladder neck associated PUV, concomitant BNI with PVA doesn't reduce early re-intervention rate.

The bladder contractility and bladder outlet obstruction indices in children. Results of a global Delphi consensus study

“…The availability of useful indices could be vital in selecting pediatric conditions. Bladder neck incision in children previously treated for posterior urethral valves has often relied on anatomical appearance rather than videourodynamics 21 . Establishment of valid indices of obstruction and contractility might avoid potentially unindicated interventions.…”

“…Bladder neck incision in children previously treated for posterior urethral valves has often relied on anatomical appearance rather than videourodynamics. 21 Establishment of valid indices of obstruction and contractility might avoid potentially unindicated interventions. While uncommon, primary bladder neck obstruction has been described in boys.…”

Upper tract urothelial carcinoma and bladder cancer in review in this number of International Brazilian Journal of Urology

“…Dr. Abdelhalim and colleagues from Egypt performed in page 485 the paper that is the cover in this edition (6). In this paper the authors assess the effect of bladder neck morphology and its incision (BNI) in patients with posterior urethral valve (PUV) on early reintervention rate and concluded that in morphologically high bladder neck associated PUV, concomitant BNI with posterior valve ablation doesn't reduce early re-intervention rate.…”