The Effects of Bladder Neck Incision on Urodynamic Abnormalities of Children With Posterior Urethral Valves

Kajbafzadeh, Abdol‐Mohammad; Payabvash, Seyedmehdi; Karimian, Golnar

doi:10.1016/j.juro.2007.07.046

Cited by 40 publications

(22 citation statements)

References 20 publications

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“…However, experience in infants is lacking. The use of simultaneous bladder neck incision at 06:00 at the time of PUV incision has also been demonstrated to improve bladder functional outcome versus PUV incision alone [Kajbafzadeh et al 2007]. However, this was in a cohort of patients of average age 1.6 years at presentation.…”

Section: Posterior Urethral Valvesmentioning

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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Section: Posterior Urethral Valvesmentioning

confidence: 99%

Best practice in the assessment of bladder function in infants

Guerra

Leonard

Castagnetti

2014

Therapeutic Advances in Urology

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“…2) except the patient with PUV. Two patients were successfully treated with clean intermittent catheterization and prophylactic antibiotic administration (2) and valve ablation and bladder neck incision (9) as previously described [17]. Patient 5 underwent surgical exploration and testis biopsy in another center.…”

Section: Resultsmentioning

confidence: 99%

Management of recurrent epididymitis in children: Application of neurovascular sparing vas clipping in refractory cases

Kajbafzadeh

Shirazi

Dianat

et al. 2011

Journal of Pediatric Urology

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“…In 2007, 'careful' BNI-at the 6 o'clock position through the bladder neck just proximal to the verumontanum, cautiously leaving the adventitia untouched-was 'res urrected' , being suggested as method to safely preserve antegrade ejaculation. 51 Impaired bladder emptying might also be explained by reasons related to the original surgical procedure to correct the PUV. For example, the valve ablation might have been incomplete, or induced scartissue formation that caused residual or recurrent obstruction.…”

Section: Effects Of Treatment On Bladder Functionmentioning

confidence: 99%

“…27,57 In addition, αblockers (αadrenergic antagonists) and BNI can facilitate bladder emptying. 25,30,51,58 Oxybutynin-an anticholinergic agent that decreases muscle spasms of the bladder-has been used in older children (all ages) to treat incontinence as well as 'younger' (undefined) patients to treat poor bladder compliance in patients with PUV. 20,25,48 Despite various treatment options for lower urinary tract dysfunction, some patients with PUV require bladder augmentation later in childhood, although the reports on these patients are scant.…”

Section: Treatment Of Bladder Dysfunctionmentioning

confidence: 99%

“…Although various treatment modalities (temporary diversions, anticholinergics, αblockers, BNIs, CICs and overnight bladder draining) have been reported to improve both lower and upper urinary tract function in childhood, the longterm effects beyond childhood are unknown. 25,27,30,51,56,65 Most adult series have investigated only small cohorts of patients and neither the selection criteria nor the evaluation of LUTS have been described fully. Most adult patients seem to not have severe LUTS, despite the increased prevalence of symptoms compared with the normal population.…”

Section: Treatment Of Bladder Dysfunctionmentioning

confidence: 99%

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Effects of posterior urethral valves on long-term bladder and sexual function

2012

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Bladder function is often compromised in juvenile patients with posterior urethral valves (PUV). In infancy, such abnormal bladder function is characterized by low compliance or overactivity, but later in life the bladder tends to become oversized and empties poorly. Polyuria, which is often associated with renal failure as well as secondary changes in the bladder neck, also has an effect on bladder function. Perhaps as a consequence of these contributing factors, toilet training is often delayed in children with PUV. Adults who were treated for PUV as a child tend to experience lower urinary tract symptoms at a rate twofold to threefold higher than healthy men. Furthermore, these adult patients with PUV might have risk factors for sexual and fertility dysfunctions later in life, such as cryptorchidism, renal failure and abnormal posterior urethra. However, despite the high incidence of these risk factors, sexual function and fertility seems to be normal in most patients.

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The Effects of Bladder Neck Incision on Urodynamic Abnormalities of Children With Posterior Urethral Valves

Abstract: Valve ablation with bladder neck incision may result in better bladder urodynamic function in comparison to simple valve ablation. However, long-term studies with followup through puberty are required to evaluate the final effects on renal function.

Cited by 40 publications

References 20 publications

Best practice in the assessment of bladder function in infants

Best practice in the assessment of bladder function in infants

Management of recurrent epididymitis in children: Application of neurovascular sparing vas clipping in refractory cases

Effects of posterior urethral valves on long-term bladder and sexual function

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