Category: Endoscopic

MP21-14 - Early Outcome of Concomitant Bladder Neck Incision with Posterior Urethral Valve Ablation: A prospective randomized Study.

Sat, Sep 22
2:00 PM - 4:00 PM

Introduction & Objective :

Scarce data exists about the value of bladder neck incision (BNI) together with posterior urethral valve (PUV) ablation. The aim of this work is to evaluate the early outcome of combined BNI and PUV ablation in infants.


Methods :

It is a prospective randomized study carried out between January 2014 and December 2016. The inclusion criteria included Denovo cases, infants younger than 1 year with no history of vesicostomy or upper tract diversion.
All cases were evaluated preoperatively by history taking including prenatal events and thorough physical examination. Serum creatinine (Cr) and complete blood count (CBC) , Renal and bladder ultrasound (RBUS), voiding cystourethrography (VCUG) and DTPA renogram were all requested preoperatively .Follow up visits were at 3 and 6 months postoperative with Cr and RBUS being done every time while VCUG and renogram only at the second visit.
A total of 145 cases were assigned into one of two groups randomly. The first group (group A) was subjected to endoscopic PUV ablation at 5,7  and 12 o'clock only and comprised 75 cases, while the second group (group B) underwent PUV ablation plus BNI and included 70 patients.
The primary end points were improvement of hydronephrosis (HN) grade, renal function and the secondary end point was resolution or downgrading of vesicoureteric reflux (VUR) in refluxing renal units.


Results :

Mean±SD patient age was 5.2 ± 1.8 months, mean BMI was 18 ± 2.8. The mean follow up duration was 17 ± 6.8 months. Improvement of
HN grade was noticed in 50 patients (67%) in group A, and 51 patients (73%) in group B, while it was static in 23 patients (31%) in group A, and 17 patients (24%) in group B (p= 0.70).
Improvement of grade of VUR occurred in 45 patients (60%) in group A, and 52 patients (74%) in group B, while it was static in 28 patients (37 %) in group A, and 16 patients (23%) in group B (p= 0.2). Improvement of glomerular filtration rate (GFR) was found in 50 patients (67%) in group A, and in 52 patients (74%) in group B, while it was static in 22 patients (29.3%) in group A and 16 patients of group B (23%) (p= 0.66). Two patients in group A, and one patient in group B developed ESRD (p =0.71).


Conclusions :

In infants with PUV, concomitant BNI with PUV ablation resulted in better early outcome in terms of improvement of HN grade, renal function and grade of VUR despite not reaching statistical significance. Long term larger prospective randomized trials are needed to identify the exact value of BNI with PUV ablation on both the upper tract and continence at age of toilet training.

Ahmed Glal

Research fellow at mansoura urology and nephrology center
UROLOGY AND NEPHROLOGY CENTER MANSOURA UNIVERSITY
Mansoura, Ad Daqahliyah, Egypt

Mansoura university hospitals
Mansoura urology and nephrology center
research fellow

Hesham Arab

assistant lecturer at mansoura urology and nephrology center
Mansoura, Ad Daqahliyah, Egypt

Tamer Helmy

assistant professor at mansoura urology and nephrology center
mansoura, Ad Daqahliyah, Egypt

Mohamed Dawaba

professor at mansoura urology and nephrology center
Mansoura, Ad Daqahliyah, Egypt

Ahmed Abdelhalim

assistant lecturer at mansoura urology and nephrology center
Mansoura, Ad Daqahliyah, Egypt

Helmy Omar

Research fellow at mansoura urology and nephrology center
Mansoura, Ad Daqahliyah, Egypt

Ashraf T. Hafiz

professor at mansoura urology and nephrology center
mansoura, Ad Daqahliyah, Egypt