Long-term Impacts of Concurrent Posterior Urethral Valve Ablation and Bladder Neck Incision on Urinary Continence and Ejaculation

Keihani, Sorena; Kajbafzadeh, Abdol‐Mohammad; Kameli, Seyedeh Maryam; Abbasioun, Reza

doi:10.1016/j.urology.2016.09.036

Cited by 20 publications

(7 citation statements)

References 17 publications

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“…37,38 Incontinence generally resolves by young adulthood, perhaps due to the growth of the prostate. 39,40 The etiology of urinary incontinence, if it persists, is likely multifactorial, and may be due to a sphincteric injury at the time of the valve ablation, overflow incontinence, detrusor overactivity, reduced bladder sensation, and nephrogenic diabetes insipidus (DI). In the young adult, nephrogenic DI and the large volumes of urine output may manifest as frequent voiding and nocturia.…”

Section: Bladder Dysfunctionmentioning

confidence: 99%

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All grown up: A transitional care perspective on the patient with posterior urethral valves

Keays

McAlpine

Welk

2018

CUAJ

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Section: Bladder Dysfunctionmentioning

confidence: 99%

“…Posterior urethral valves preserved among PUV patients, even in those who underwent a bladder neck incision as an infant. 40…”

Section: S13mentioning

confidence: 99%

All grown up: A transitional care perspective on the patient with posterior urethral valves

Keays

McAlpine

Welk

2018

CUAJ

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“…In a study by Kajbafzadeh et al, no retrograde ejaculation was found after BNI at young age and no reduced sperm volume with normal sperm count in one out of six patients (20). Keihani et al found similar results in 18 young adult men after concurrent treatment of PUV and BNI (21). The fact that a unilateral superficial BNI was done, only incising the obstructive ring, and thereby avoiding damage to the internal sphincter may contribute to the absence of retrograde ejaculation.…”

Section: Discussionmentioning

confidence: 71%

The Long-term Effect of Superficial Bladder Neck Incision on Ejaculation and Incontinence in Boys with Primary and Secondary Bladder Neck Obstruction

et al. 2017

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ObjectiveSuperficial bladder neck incision (SBNI) is controversial at young age, with retrograde ejaculation after puberty as main concern. The aim of the study is to investigate the long-term effect of SBNI on ejaculation and incontinence in boys with primary and secondary bladder neck obstruction (BNO).Materials and methodsIn boys with infravesical obstruction, SBNI was performed in case of a persistent BNO after earlier desobstruction or in case of primary severely obstructive bladder neck. SBNI was performed with a diathermy hook, always superficially (2–3 mm) and unilaterally at 7 O’clock. Males that had SBNI during childhood after posterior urethral valve incision or relief of other obstruction between 1986 and 2003 were included. Evaluation was done by International Continence Society male sex questionnaire, International Prostate Symptom Score, developmental International Consultation Modular Questionnaire on Urinary Incontinence, frequency volume chart, and uroflowmetry.ResultsOf 79 traceable patients, 40 (50.6%) participated. Of these, 37 (92.5%) completed all questionnaires and 28 (70%) performed uroflowmetry. Median age at SBNI was 4.7 years [interquartile range (IQR) 0.6–8.5] and was 19.6 years (IQR 17.3–20.9) at follow-up. All men had antegrade ejaculation, 4/37 (10.8%) reported possibly reduced ejaculatory volume. Eight (22%) had moderate lower urinary tract symptoms and two (5.4%) had moderate incontinence. Median maximum flow rate was 30.1 mL/s (IQR 24.4–42.6).ConclusionSBNI in boys with severe infravesical obstruction can be done safely with preservation of antegrade ejaculation and no additional lower urinary tract dysfunction.

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“…This practice was previously abandoned as it was thought to cause incontinence, dry or retrograde ejaculation. However, a study by Keihani et al 14 did not show ejaculatory dysfunction or incontinence at the follow-up assessments.…”

Section: Discussionmentioning

confidence: 92%

Can the posterior:anterior urethral ratio on voiding cystourethrogram be used as a reliable predictor of successful posterior urethral valve ablation in male children?

Gaibie¹,

Mahomed²,

Petersen³

et al. 2020

South African Journal of Radiology

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Background The role of the voiding cystourethrogram (VCUG) in the follow-up of children with posterior urethral valves (PUVs) post-ablation has been considered a standard practice. The urethral ratio and gradient of change have proven to be useful. Objectives We aimed to review the role of the ‘ideal’ ratio on predicting residual PUV post-ablation. Methods A systematic review of the PubMed, SCOPUS and Web of Science databases was performed (April 2019). The search terms included ‘Urethral Ratio and Posterior urethral valve ablation’. All cited reference lists were further evaluated for additional inclusive studies. Results Eleven studies were identified, of which nine were relevant to the topic. Case reports, comments and adult and animal studies were excluded, leaving four studies for critical review. In total, 338 patients were assessed. The control group consisted of 167 age-matched, male children. Study regions included India and Australia. The ages ranged from 15 days to 3.4 years. Ablation methods included the use of a resectoscope with cutting diathermy, cold knife or Bugbee electrode. The mean urethral ratios in the control group ranged from 1.04 to 1.73. The suggested predictive urethral cut-off ratios recommended include 2.2 ( p = 0.001), 2.5–3 and 3.5. Conclusion Although the precise cut-off ratio could not be clearly defined in this review, a urethral ratio less than a range of 2.2–3.5 has proven to be a beneficial predictor of ablation success and should thus be incorporated into standard VCUG reporting templates in the follow-up of PUVs in male children in resource-limited settings.

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Long-term Impacts of Concurrent Posterior Urethral Valve Ablation and Bladder Neck Incision on Urinary Continence and Ejaculation

Cited by 20 publications

References 17 publications

All grown up: A transitional care perspective on the patient with posterior urethral valves

All grown up: A transitional care perspective on the patient with posterior urethral valves

The Long-term Effect of Superficial Bladder Neck Incision on Ejaculation and Incontinence in Boys with Primary and Secondary Bladder Neck Obstruction

Can the posterior:anterior urethral ratio on voiding cystourethrogram be used as a reliable predictor of successful posterior urethral valve ablation in male children?

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