URODYNAMIC ASSESSMENT IN THE MANAGEMENT OF THE CHILD'S POSTERIOR URETHRAL VALVES
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Abstract
Background: Bladder dysfunction may be associated with valves of the posterior urethra. Their evaluation by urodynamic assessment is an important parameter for the therapeutic management. The objective of our study was to study the contribution of urodynamic assessment in the management of valves of the posterior urethra of the child.
Methods: Our study was descriptive, retrospective, involving 43 children with posterior urethral valves (PUV), followed at the pediatric ward at Charles Nicolle Hospital in Tunis from January 1995 to December 2015. All the children had an urodynamic assessment after valves of the posterior urethra treatment.
Results: The mean age was 15.8 months. Preoperatively, creatinine clearance was below 60 ml / min in 32 patients (74%). The worsening of renal function was noted in 32 (74%). A significant post-voiding residue proved in 34 patients (79%). Cystometry revealed a hypo compliant bladder in 24 (56%), low bladder capacity in 42% of cases; a hypertonic detrusor in 37% of cases. Bladder sphincter dyssynergia was diagnosed in 6 patients. Like urodynamic assessment data, bladder enlargement associated with a Mitrofanoff-type shunt was indicated and performed in 3 patients (7%).
Conclusion: Through our study, the urodynamic profile made it possible to specify the type of vesico-sphincter dysfunctions persistent in patients operated for PUV, and subsequently to adapt the therapeutic conduct in these patients. Given the lack of management and the consequences on the health of the child as well as on his quality of life, reflections on the preventive and therapeutic approach after PUV treatment are necessary.
Keywords:
posterior urethra valves - urodynamic test - intermittent catheterization - chronic renal failure##plugins.themes.academic_pro.article.details##
References
- 1. Donohoe JM, Weinstein RP, Combs AJ, Misseri R, Horowitz M, Schulsinger D, et al. When can persistent hydroureteronephrosis in posterior urethral valve disease be considered residual stretching?. J Urol. 2004;172(2):706-11. 2. Davody et al. Les valves de l'urèthre postérieur chez le nouveau-né et le nourrisson Traitement et évolution. Prog Urol. 1992;2:901‑7. 3. Ghanem MA, Wolffenbuttel KP, De Vylder A, Nijman RJ. Long-term bladder dysfunction and renal function in boys with posterior urethral valves based on urodynamic findings. J Urol. 2004;171(6):2409-12. 4. Neveus T, von Gontard A, Hoebeke P,HjälmÃ¥s K, Bauer S, Bower W et al. The standardization of terminology of lower urinary tract function in children and adolescents: Report from the standardisation committee of the international children's continence society. J Urol. 2006;176:314-24. 5. Morris RK, Kilby MD: Long-term renal and neurodevelopmental outcome in infants with LUTO, with and without fetal intervention. Early Hum Dev. 2011; 87 (9): 607-10. 6. Khursigara N, McGuire BB, Flood H: Late presentation of posterior urethral valves. Can J Urol. 2011; 18 (3): 5739-41. 7. Riah L, Belhaj K, Lmidmani F, El Fatimi A, El Kettani Y, El Ayoubi M, et al. Urodynamic profile of voiding disorders persisting after treatment of posterior urethral valve. Prog Urol. 2015;25(4):217-23. 8. Dinneen MD, Duffy PG. Posterior urethral valves. Br J Urol 1996;78: 275-81. 9. De Gennaro M, Capitanuci ML, Mosiello G, Caione P, Silveri M. The changing urodynamic pattern from infancy to adolescence in boys with posterior urethral valves. BJU Int. 2000; 85:1104-8. 10. Sarhan OM, El-Ghoneimi AA, Helmy TE, Dawaba MS, Ghali AM, Ibrahiem el-HI: Posterior urethral valves: multivariate analysis of factors affecting the final renal outcome. J Urol. 2011;185: 2491-5. 11. Woodhouse CR: The fate of the abnormal bladder in adolescence. J Urol. 2001, 166 (6):2396-400. 12. Sanna-Cherchi S, Ravani P, Corbani V, et al. Renal outcome in patients with congenital anomalies of the kidney and urinary tract. Kidney Int. 2009; 76: 528-33. 13. Sarhan OM, El-Ghoneimi AA, Helmy TE, Dawaba MS, Ghali AM, Ibrahiem el-HI: Posterior urethral valves: multivariate analysis of factors affecting the final renal outcome. J Urol. 2011;185: 2491-5. 14. Bael A, Lax H, de Jong TP, Hoebeke P, Nijman RJ, Sixt R, et al. The relevance of urodynamic studies for Urge syndrome and dysfunctional voiding: a multicenter controlled trial in children. J Urol. 2008;180(4):1486-93. 15. Moscovici J. Urination disorders revealing posterior urethral valve: urodynamic aspects. Arch Pediatr. 1997;4 Suppl 1:19-22. 16. Ansari MS, Srivastava A, Kapoor R, Dubey D, Mandani A, Kumar A. Biofeedback therapy and home pelvic floor exercises for lower urinary tract dysfunction after posterior urethral valve ablation. J Urol. 2008;179(2):708-11. 17. Desai DY. A review of urodynamic evaluation in children and its role in the management of boys with posterior urethral valves. Ind J Urol. 2007;23(4):435-42. 18. Dewan P. The impact of late presentation of posterior urethral valves on bladder and renal function. J Urol. 2006;176(6):2748. 19. Lopez Pereira P, Martinez Urrutia MJ, Espinosa L, Lobato M,Navarro M, Jaureguizar E. Bladder dysfunction as a prognostic factor in patients with posterior urethral valves. BJU Int. 2002;9:308-11. 20. Austin PF, Bauer SB, Bower W, Chase J, Franco I, Hoebeke P et al. The standardization of terminology of lower urinary tract function in children and adolescents: Report from the standardisation committee of the international children's continence society. J Urol. 2014;191:1863-65. 21. Hjalmas K. Urodynamics in normal infants and children. Scand J Urol Nephrol. 1988;114:20-27. 22. Kajbafzadeh AM, Payabvash S, Karimian G. The effects of bladder neck incision on urodynamic abnormalities of children with posterior urethral valves. J Urol. 2007;178(5):2142-7. 23. Schulte-Baukloh H, Michael T, Sturzebecher B, Knispel HH.Botulinum-A toxin detrusor injection as a novel approach inthe treatment of bladder spasticity in children with neurogenicbladder. Eur Urol. 2003;44:139-43. 24. Opsomer R, Feyarts A, Wese FX. La dyssynergie vésico-sphinctérienne fonctionnelle. In: L'hypertonie périnéale. Paris:DaTeBe eds; 2004. p. 81-92. 25. Lopez Pereira P, Miguel M, Martinez Urrutia MJ, Moreno JA, Marcos M, Lobato R, et al. Long-term bladder function, fertility and sexual function in patients with posterior urethral valves treated in infancy. J Pediatr Urol. 2013;9(1):38-41. 26. Harris CF, Cooper CS, Hutcheson JC, Snyder HM, 3rd. Appendicovesicostomy: the mitrofanoff procedure-a 15-year perspective. J Urol. 2000;163(6):1922-6. 27. Hebenstreit D, Dagmar C, Karin H, Thomas MS, Gabriela B, Alexander S. , Long- term outcome of pediatric renal transplantation in boys with posterior urethral valves, J Pediatr Surg. 2018. 53 (11): 2256-60. 28. Ross JH, Kay R, Novick AC, Hayes JM, Hodge EE, Streem SB. Long-Term Results of Renal Transplantation into the Valve Bladder. J Urol. 1994;151(6):1500‑4. 29. Connolly JA, Miller B, Bretan PN. Renal transplantation in young boys with posterior urethral valves: favourable long-term outcome. J Urol. 1995; 154: 1153-5.