Urodynamic profile in posterior urethral valve patients following fulguration: Does age at fulguration matter?

Outcome of Endoscopic Ablation of Late-childhood Posterior Urethral Valves: Case Series and Literature Review

OBJECTIVE

This study aimed to evaluate the outcomes of endoscopic valve ablation (EVA) in children diagnosed with posterior urethral valves (PUV) during late childhood (LC-PUV).

METHODS

Retrospective analysis of prospectively maintained database of 53 children aged 5-15 years who underwent EVA for PUV at a single institution between 2002 and 2023. Data on mode of presentation, pre-operative investigations, intra-operative findings, and post-operative outcomes were reviewed. Primary outcome assessed symptom resolution, while secondary outcomes included changes in uroflowmetry, urinary tract imaging and urodynamics.

RESULTS

The median age at the time of EVA was 8.5 years. Symptoms at presentation were predominantly storage-related, with urge urinary incontinence (47.2 %) being most common. Post-operatively, 64 % of patients showed significant symptomatic improvement, with 28 % achieving complete resolution. Urodynamic studies demonstrated a significant increase in Q-max (mean 21.9 ml/s post-EVA vs. 10.3 ml/s pre-EVA, p < 0.001), and reduction in mean detrusor voiding pressure (p < 0.05) after endoscopic ablation. Long-term bladder dysfunction persisted in 65% of cases, and 28 % showing structural renal damage post-EVA.

CONCLUSION

Diagnosis of LC-PUV requires high-level of suspicion given the nonspecific presentation. Endoscopic valve ablation is associated with high success rates both subjectively and objectively. Long-term surveillance is essential due to substantial risk of residual bladder dysfunction and CKD.