BERKELEY, CA (UroToday.com) - Congenital membranous obstruction of the proximal urethra caused by posterior urethral valves (PUV) may have injurious effect on the bladder and kidneys.
Resection of the valves does not always protect from anatomical and functional disorders. Hence, lower urinary tract dysfunction is frequently observed among boys with PUV.
Three different dominating urodynamic patterns have been identified in PUV children: detrusor overactivity, low bladder compliance, and underactive detrusor. It has been suggested that overactive detrusor in infancy has the tendency of becoming underactive with increasing age. In addition, secondary to renal failure, the patients may also have polyuria affecting bladder function further. It has been shown that urinary incontinence is common among boys with PUV, and that PUV patients attain continence with delayed age. However, there is a dire lack of studies assessing adult bladder function in these patients. We aimed to explore lower urinary tract symptoms (LUTS) in adults treated for PUV in childhood, and compare them with population-based, age- and sex-matched controls.
Questionnaires were mailed to PUV patients aged 18 or higher treated for PUV at our institution. Out of 106 PUV patients, 68 (64 %) returned the questionnaire. Age- and sex-matched controls were randomly identified from a population-based study (response proportion 62 %). The Danish Prostatic Symptom Score (DAN-PSS) was used for the assessment of occurrence (scale for most: never-rarely-often-always) and bother (scale for all: none-small-moderate-major) of 12 different LUTS.
The median age of the 68 PUV patients and the 272 controls (ratio 1:4) was 38.5 years (range 18-57). One third of the patients described at least one moderate to severe LUTS compared to one sixth of controls. Mild hesitancy, weak stream, incomplete emptying and straining were twice as common in PUV patients than controls. Prevalence of any urgency incontinence and any stress incontinence was at least three-fold in PUV patients compared to controls. At least moderate bother from LUTS was reported by one in seven PUV patients and one in eleven controls.
Overall, the occurrence and bother of most LUTS is approximately 2-fold in PUV patients compared to controls. Although, in this cohort of young and middle-aged men, most symptoms are not severe or very bothersome, these results suggest that PUV in childhood is a clear risk factor for LUTS in adulthood, which may not have been addressed properly in adult urology.
J. Heikkilä, K.A.O. Tikkinen, and S. Taskinen as part of Beyond the Abstract on UroToday.com. This initiative offers a method of publishing for the professional urology community. Authors are given an opportunity to expand on the circumstances, limitations etc... of their research by referencing the published abstract.