Long-Term Bladder Dysfunction and Renal Function in Boys With Posterior Urethral Valves Based on Urodynamic Findings

Ghanem, Mazen A.; Wolffenbuttel, Katja P.; Vylder, Ann De; Nijman, Rien J.M.

doi:10.1097/01.ju.0000127762.95045.93

Cited by 83 publications

(29 citation statements)

References 19 publications

(30 reference statements)

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“…Historically, there have been concerns over the suitability of RTx for patients with ESRD resulting from LUTD because of the expected higher risks of UTI and other urological [2,3]. Although some authors confirmed that outcomes for RTx in children with LUTD were similar to those in children with normal lower urinary tracts [9][10][11][12][13][14], LUTD may have a significant impact on graft survival if not managed appropriately [4,15]. Low intravesical pressure with adequate bladder capacity and compliance, together with efficient drainage, should be achieved for a successful transplantation [11,12,[16][17][18].…”

Section: Discussionmentioning

confidence: 99%

Outcomes of living donor renal transplantation in children with lower urinary tract dysfunction: a comparative retrospective study

et al. 2015

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ObjectivesTo compare outcomes of renal transplantation (RTx) in children with end-stage renal disease (ESRD) resulting from lower urinary tract dysfunction (LUTD) vs other causes. Patients and MethodsA database of children (<18 years old) who underwent RTx between May 2008 and April 2012 was reviewed. Patients were divided into those with LUTD (group A, n = 29) and those with other causes of ESRD (group B, n = 74). RTx was performed after achieving low intravesical pressure (<30 cmH 2 O) with adequate bladder capacity and drainage. The groups were compared using Student's t-test, MannWhitney, chi-squared or exact tests. Graft survival rates (GSRs) were evaluated using Kaplan-Meier curves and the log-rank test. ResultsThe mean AE SD (range) age of the study cohort was 5.05 AE 12.4 (2.2-18) years. Causes of LUTD were posterior urethral valve (PUV; 41.4%), vesico-ureteric reflux (VUR; 37.9%), neurogenic bladder (10.3%), prune belly syndrome (3.4%), obstructive megaureter (3.4%) and urethral stricture disease (3.4%). There was no significant difference in age, dialysis duration or donor type. In group A, 25 of the 29 patients (86.2%) underwent ≥1 surgery to optimize the urinary tract for allograft. Pretransplant nephrectomy was performed in 15 of the 29 patients (51.7%), PUV ablation in nine patients (31%) and ileocystoplasty in four patients (13.7%). The mean AE SD follow-up was 4.52 AE 1.55 and 4.07 AE 1.27 years in groups A and B, respectively. There was no significant difference in creatinine and eGFR between the groups at different points of follow-up. The GSRs at the end of the study were 93.1 and 91.1% in groups A and B, respectively (P = 1.00). According to Kaplan-Meier survival curves, there was no significant difference in the GSR between the groups using the log-rank test (P = 0.503). No graft was lost as a result of urological complications. In group B, one child died from septicaemia. The rate of urinary tract infections was 24 and 12% in groups A and B, respectively, but was not significant. No significant difference was found between the groups with regard to the incidence of post-transplantation hydronephrosis. Of the 22 patients who had hydronephrosis after transplantation, three were complicated by UTI. Injection of bulking agents was required in two patients for treatment of grade 3 VUR. In the third patient, augmentation cystoplasty was needed. ConclusionAcceptable graft function, survival and UTI rates can be achieved in children with ESRD attributable to LUTD. Thorough assessment and optimization of LUT, together with close follow-up, are key for successful RTx.

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Section: Discussionmentioning

confidence: 99%

Outcomes of living donor renal transplantation in children with lower urinary tract dysfunction: a comparative retrospective study

et al. 2015

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“…The implications of bladder dysfunction in patients with valves are also well known. Poor bladder compliance and detrusor overactivity were shown to significantly correlate with renal functional impairment; however, normal urodynamic findings did not preclude upper tract deterioration [Ghanem et al 2004].…”

Section: Urodynamics In Intrinsic Bladder and Urethral Abnormalities mentioning

confidence: 99%

Best practice in the assessment of bladder function in infants

Guerra

Leonard

Castagnetti

2014

Therapeutic Advances in Urology

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Abstract:The purpose of this article is to review normal developmental bladder physiology in infants and bladder dysfunction in conditions such as neurogenic bladder, posterior urethral valves and high grade vesicoureteric reflux. We contrast the classical concept that bladder function in nontoilet-trained children is thought to be 'reflexive' or 'uninhibited', with the results of more recent research showing that infants most commonly have a stable detrusor. The infant bladder is physiologically distinct from the state seen in older children or adults. The voiding pattern of the infant is characterized by an interrupted voiding stream due to lack of proper urinary sphincter relaxation during voiding. This is called physiologic detrusor sphincter dyscoordination and is different from the pathologic 'detrusor sphincter dyssynergy' seen in patients with neurogenic bladder. Urodynamic abnormalities in neonates born with spina bifida are common and depend on the level and severity of the spinal cord malformation. Upper neuron lesions most commonly lead to an overactive bladder with or without detrusor sphincter dyssynergy while a lower neuron lesion is associated with an acontractile detrusor with possible denervation of the external urinary sphincter. In infants with neurogenic bladder, the role of 'early prophylactic treatment (clean intermittent catheterization and anticholinergics)' versus initial 'watchful waiting and treatment as needed' is still controversial and needs more research. Many urodynamic-based interventions have been suggested in patients with posterior urethral valves and are currently under scrutiny, but their impact on the long-term outcome of the upper and lower urinary tract is still unknown. Cumulative data suggest that there is no benefit to early intervention regarding bladder function in infants with high-grade vesicoureteric reflux.

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“…Urethral stricture may occur after valve ablation in a minority of cases and can be successfully treated endoscopically. Loop resection is associated with more strictures.Posterior urethral valves (PUVs) are the most common cause of congenital bladder outlet obstruction in boys [1,2] and cause renal failure in 25% to 30 % of cases before adolescence [2][3][4]. The severity of PUV varies from mild to lethal according to the degree of obstruction [5].…”

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confidence: 99%

Surgical complications of posterior urethral valve ablation: 20 years experience

Sarhan

El-Ghoneimi

Hafez

et al. 2010

Journal of Pediatric Surgery

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Long-Term Bladder Dysfunction and Renal Function in Boys With Posterior Urethral Valves Based on Urodynamic Findings

Abstract: Bladder dysfunction may contribute to renal function impairment eventually but normal urodynamic findings do not preclude renal deterioration. It is likely that loss of compliance and detrusor overactivity would actually result in a valve bladder reaching its end point function.

Cited by 83 publications

References 19 publications

Outcomes of living donor renal transplantation in children with lower urinary tract dysfunction: a comparative retrospective study

Outcomes of living donor renal transplantation in children with lower urinary tract dysfunction: a comparative retrospective study

Best practice in the assessment of bladder function in infants

Surgical complications of posterior urethral valve ablation: 20 years experience

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