Posterior urethral valves represent a congenital condition, with a prevalence of 2.48 per 10,000 live births, which very often deals with bladder problems. It is one of the main issues of clinical urodynamic in children.
A great proportion of patients suffer from urinary incontinence, and bladder dysfunction was seen in many of them (55%, 0–72%) after primary treatment. Despite early relief of obstruction, pathological changes in the bladder can cause bladder dysfunction and consequent progressive slow deterioration of the upper urinary tract drainage with renal failure, possibly leading to renal insufficiency over years. Thus, prevention and treatment of bladder dysfunction, based on urodynamic observations, are mandatory in terms of long-term outcome. Over time abnormal urodynamic patterns of myogenic failure, detrusor overactivity, and decreased compliance/small capacity (so-called valve bladder) may develop. In addition, urodynamic bladder function may change with time, leading with myogenic failure in some postpubertal patients, most likely secondary to increased urine production and persistence of functional bladder neck outlet obstruction impairment.
Nowadays, differently than in the past when aggressive surgical approaches were claimed, a conservative management was shown more effective and safe, following primary neonatal valves ablation. An accurate and early toilet training program, a strict follow-up mainly based on not invasive urodynamic evaluations, and an advanced urotherapy program with associate appropriate drugs therapy are effective to prevent and treat bladder dysfunction in children with urethral valves. The cases leading with renal insufficiency, polyuria, upper urinary tract deterioration, and, ultimately, kidney transplant need more aggressive investigations and treatments.
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