Tang Liangfeng,Sun Yubo,Wang Anle,et al.Incontinence and changes in urodynamics and renal function in children with posterior urethral valves[J].Journal of Clinical Pediatric Surgery,,():627-631.[doi:10.3760/cma.j.cn101785-20260408-00164]
Incontinence and changes in urodynamics and renal function in children with posterior urethral valves
- Keywords:
- Posterior Urethral Valve; Urodynamic Study; Bladder Compliance; Urinary Incontinence; Child
- Abstract:
- Objective To follow up with postoperative children with posterior urethral valves,examine the changes in urinary incontinence symptoms from preschool to school age and explore the characteristics of bladder and kidney function changes. Methods This study retrospectively analyzed the clinical data of children with urethral valve disease who recovered smoothly after surgery and were admitted to Fudan University Affiliated Children’s Hospital from January 2018 to December 2025.A total of 33 eligible children were included with a median age of 4.2 years for an initial urodynamic examination.According to the symptoms at the time of enrollment,they were assigned into groups without incontinence symptoms (group A,n=12) and with urinary incontinence symptoms (n=21).The latter was further divided into remission group (group B,n=7) and non-remission group (group C,n=14) based upon urinary incontinence symptoms at the end of follow-ups.Baseline profiles,renal function and urodynamic indicators as well as the changes in kidney and bladder function during follow-ups were compared among the groups.Results No significant differences existed in serum creatinine,glomerular filtration rate or bladder capacity at the time of enrollment.Bladder compliance of group C was 5.54(3.63,8.74)mL/cmH2O.It was worse than group A’s 9.49(6.85,13.57)mL/cmH2O and group B’s 19.38(4.40,24.25)mL/cmH2O,(P=0.047).The median follow-up period was 3.5 years and the median age of the last follow-up 7.9 years.The changes (elevation) of serum creatinine during the period were 13.30(7.20,18.50)μmol/L,22.00(12.20,28.40)μmol/L and 6.20(3.70,19.90)μmol/L in each group,respectively (P=0.098).During follow-ups,remission group showed a greater spike in creatinine.However,the difference was not statistically significant.Bladder compliance for each group were 12.4(7.5,26.4),17.2(10.8,25.8) and 6.5 (5.4,11.7)mL/cmH2O at the end of follow-up respectively (P=0.055).Bladder compliance of group C was slightly worse.However,the difference was not statistically significant.The mixed model test results indicated that time was the most significant factor affecting bladder compliance changes,with an effect coefficient of 9.17(2.06,16.28) for the number of follow-up visits.And it ch was statistically significant (P=0.011).Conclusion Bladder compliance and urinary incontinence symptoms of children with posterior urethral valves show an improvement trend with age in pre-school period.Children with persistent urinary incontinence may have worse bladder compliance.
References:
[1] 中华医学会小儿外科学分会泌尿外科学组.儿童后尿道瓣膜症诊疗的专家共识[J].中华小儿外科杂志,2021,42(7):577-582.DOI:10.3760/cma.j.cn421158-20201125-00717. Group of Urology Surgery,Branch of Pediatric Surgery,Chinese Medical Association.Expert Consensus on Treating Posterior Urethral Valves[J].Chin J Pediatr Surg,2021,42(7):577-582.DOI:10.3760/cma.j.cn421158-20201125-00717.
[2] Hunt EAK,Stein DR.Beyond childhood:the lifelong kidney risks for children with posterior urethral valves[J].J Am Soc Nephrol,2024,35(12):1633-1635.DOI:10.1681/ASN.0000000545.
[3] Kahraman K,G?knar N.Impact of posterior urethral valve on patient quality of life and caregiver burden[J].World J Urol,2025,43(1):582.DOI:10.1007/s00345-025-05970-1.
[4] 中华医学会小儿外科学分会小儿尿动力和盆底学组.儿童尿失禁临床诊治中国专家共识(2024年版)[J].临床小儿外科杂志,2024,23(3):201-209.DOI:10.3760/cma.j.cn101785-202302006-001. Groups of Pediatric Urodynamics and Pelvic Floor,Branch of Pediatric Surgery,Chinese Medical Association:Chinese Expert Consensus on Clinical Diagnosis and Treatment of Urinary Incontinence in Children[J].J Clin Ped Sur,2024,23(3):201-209.DOI:10.3760/cma.j.cn101785-202302006-001.
[5] Coleman R,King T,Nicoara CD,et al.Nadir creatinine in posterior urethral valves:How high is low enough?[J].J Pediatr Urol,2015,11(6):356.e1-356.e5.DOI:10.1016/j.jpurol.2015.06.008.
[6] Paraboschi I,Marinaro M,Mishra P,et al.Toilet training achievements in children born with posterior urethral valves[J].Arch Dis Child,2025,110(9):737-741.DOI:10.1136/archdischild-2024-328149.
[7] Glassberg KI,Combs A.The valve bladder syndrome:35+ years later[J].J Urol,2016,196(1):16-17.DOI:10.1016/j.juro.2016.04.049.
[8] Glassberg KI.The valve bladder syndrome:20 years later[J].J Urol,2001,166(4):1406-1414.DOI:10.1016/S0022-5347(05)65796-5.
[9] Molina Caballero A,Pérez Martínez A,Go?i Orayen C,et al.Intravesical oxybutynin for urgent bladder rescue in a newborn with posterior urethral valves[J].European J Pediatr Surg Rep,2019,7(1):e90-e92.DOI:10.1055/s-0039-3399565.
[10] De Jesus LE.Bladder dysfunction depends on many variables in children with posterior urethral valves[J].Int Braz J Urol,2022,48(1):87-88.DOI:10.1590/S1677-5538.IBJU.2021.0046.1.
[11] Tharwat M,Ramadan R,Hashem A,et al.Bladder neck incision in posterior urethral valve management:a meta-analysis with insights into adjunctive bladder interventions[J].Curr Urol Rep,2025,27(1):1.DOI:10.1007/s11934-025-01309-w.
[12] ELghareeb A,Dawaba M,Eldeeb M,et al.Concomitant bladder neck incision in patients with posterior urethral valve and bladder neck hypertrophy:short-term outcomes of a randomized controlled trial[J].Int Braz J Urol,2026,52(3):e20250539.DOI:10.1590/S1677-5538.IBJU.2025.0539.
Memo
收稿日期:2026-4-8。
基金项目:儿科医院院级队列研究(LCDL—CB—011);厦门市新生儿疾病重点实验室开放课题(CHP—2023—XKL—010)
通讯作者:耿红全,Email:genghongquan@fudan.edu.cn