BACKGROUND: Endoscopic surgery in neonates with posterior urethral valves (PUV) has historically faced limitations due to urethral caliber and instrument size. Newer concepts have emerged to optimize successful early PUV management, however their impact on broader trends in surgical management is not well defined. We aim to describe use of PUV ablation and cutaneous vesicostomy over 20 years and to identify patient and hospital factors associated with each surgery. METHODS: Utilizing Kids’ Inpatient Database we performed a retrospective cohort study of neonates (< 28 days old) who underwent valve ablation or vesicostomy creation for PUV from 2000-2019. Patients were identified using International Classification of Diseases 10 diagnosis and procedure codes. Primary outcome was surgical technique for PUV correction. Linear regression and chi squared testing were used to assess trends over time. Multivariable logistic regression model was used to identify factors associated with each surgical method.
RESULTS: 909 neonates (weighted value) underwent surgery for PUV between 2000 and 2019. We found a significant increase in the number of neonates undergoing surgery for PUV over time (p=0.002) (Figure 1). 663 (73%) underwent primary valve ablation and 246 (27%) underwent primary vesicostomy creation. Notably, ablation comprised 44% of all PUV surgeries in 2000 and 83% of PUV surgeries by 2019. This reflects the significant increase in the proportion of patients undergoing valve ablation (p<0.001) (Figure 1). Multivariable logistic regression analysis (Table 1) showed no significant difference in surgical management with respect to insurance status, race, income, or teaching hospital status. Patients at Midwest (OR=0.46, 95% CI [0.26-0.82], p=0.008) and West (OR=0.55, 95% CI [0.32-0.95], p=0.033) region hospitals, and at medium sized hospitals (OR=0.51, 95% CI [0.33-0.78], p=0.002), were more likely to undergo ablation.
CONCLUSIONS: We observed an increase in surgical treatment of neonates with PUV over time. Since 2000, primary surgical management has shifted dramatically, with the vast majority of neonates now undergoing ablation rather than vesicostomy creation. We found no association between sociodemographic factors and treatment choice. More research is needed to better understand this changing practice pattern.