Bladder Management and Voiding Symptoms in Adult Males With A History of Posterior Urethral Valves
Douglas Coplen, MD, Gino Vricella, MD, Erica Traxel, MD.
Washington University School of Medicine and St. Louis Childrens Hospital, Saint Louis, MO, USA.
BACKGROUND: At presentation, boys with bladder outlet obstruction (BOO) secondary to posterior urethral valves (PUV) typically have detrusor hyperreflexia. After relief of BOO the extent of bladder remodeling impacting detrusor hyperreflexia is variable but is typically characterized by decreasing intravesical pressures, improved bladder compliance, and at times supranormal capacity and atony with incomplete emptying requiring clean intermittent catheterization (CIC). We evaluate voiding symptoms and bladder management in adult males with a history of PUV. METHODS: We queried our institutional PUV database for males initially treated at our institution and born prior to 2005. We ascertained age at presentation, mode of presentation, anatomic findings at presentation, renal function (CKD defined as serum creatinine >1.1 mg/dl), surgical interventions, urinary continence, bladder management and voiding symptoms/quality of life as assessed by the AUA symptom score (AUA-SS) (in patients who are voiding). AUA-SS was obtained at the most recent patient follow-up. Non-invasive uroflow and urodynamics were obtained in select patients. RESULTS: We identified 145 patients who received treatment for type I PUV between 1961 and 2005. Twenty-one are deceased (table 1). Fifty-four patients do not have follow-up past 18 years of age. There are 70 evaluable patients (follow-up of 18-57 years). Renal outcomes and bladder management are detailed in Table 2. CKD progression and need for renal replacement therapy occurred as late as the third decade of life. AUA-SS range was between 0 and 25 (mean is 7 and median is 4). There is no apparent relation between age of presentation or initial treatment (valve incision (TUI) vs. urinary diversion) and long-term bladder management or AUA-SS. CONCLUSIONS: The majority of adult males with a history of PUV have mild voiding symptoms as determined by AUA-SS. A minority have bladder hypotonia/incomplete emptying that require CIC, regardless of initial management (TUI vs diversion). Because they have minimal symptomatology these men may not seek routine urologic follow-up. They need to be counselled regarding the importance of regular follow-up. Additional patients/prospective evaluation may help determine if there is any relationship between voiding symptoms/bladder management in adult males and progression of renal disease.
| etiology | # of patients | Age at death |
| pulmonary hypoplasia/neonatal renal failure | 10 | 2-45 days (median 10 days) |
| Complications of ESRD | 5 | 16 months-38 years (median 26 years) |
| Neuromuscular disorder | 1 | 4 years |
| Status asthmaticus | 1 | 17 years |
| Post-transplant lymphoproliferative disorder | 1 | 30 years |
| Alcoholic cirrhosis | 1 | 30 years |
| Metastatic bladder adenocarcinoma | 1 | 42 years |
| Amyotrophic lateral sclerosis (ALS) | 1 | 49 years |
| Initial treatment | number | CKD | transplant | voids | CIC |
| valve incision | 36 | 15 | 4 | 33 | 3 |
| vesicostomy | 13 | 8 | 2 | 13 | 0 |
| ureterostomy | 21 | 12 | 8 | 18 | 3 |
| 70 | 35(50%) | 14(20%) | 64(91%) | 6(9%) |
Back to 2023 Abstracts