Role of Overnight Bladder Drainage in the Children with Fulgurated Posterior Urethral Valves with Deteriorating Renal Function and increasing Bladder Dysfunction.

Jyotish, Kumar (2007) Role of Overnight Bladder Drainage in the Children with Fulgurated Posterior Urethral Valves with Deteriorating Renal Function and increasing Bladder Dysfunction. Masters thesis, Christian Medical College, Vellore.


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INTRODUCTION : Posterior urethral valves are the most common cause of obstructive uropathy involving the lower urinary tract in childhood. Such patients may present from early neonatal period to late childhood with a broad spectrum of clinical severity ranging from poor urinary stream to renal failure. The increased use of antenatal ultrasound has resulted in more patients presenting in the neonatal period. The many options available in the management of the newborn with posterior urethral valves include immediate upper tract diversion, lower tract diversion, valve ablation alone, and valve ablation with immediate upper tract reconstruction. The appropriate procedure must be tailored to the status of the upper tracts. In many patients, the impairment of renal and bladder function exists despite successful early valve ablation. Increased voiding frequency, small voiding volumes, urinary incontinence and large post-void residuals are frequently observed in these children. In time, myogenic failure may occur with large bladder volumes without sense of bladder fullness and weak detrusor activity leading to valve bladder syndrome. Thus, treatment of these children with poorly compliant bladders usually involves clean intermittent catheterization (CIC) to facilitate bladder emptying and anticholinergic drugs to improve poor bladder compliance. However, in some polyuric cases even catheterization as frequently as every 2 hours is not effective to maintain “safe” bladder volumes. Furthermore, sustained bladder over distension persists during sleep, and leaves the bladder and upper tracts at risk despite frequent intermittent daytime drainage. For these cases, one suggested treatment has been the addition of overnight bladder drainage to the prescribed daytime intermittent drainage. The aim of this study is to assess the role of overnight bladder drainage (OBD) in children with fulgurated posterior urethral valves with deteriorating renal function and increasing bladder dysfunction. MATERIAL AND METHODS : Study Design - Descriptive study with prospective as well as retrospective limbs. Study Group - All children with fulgurated posterior urethral valves and deteriorating renal function undergoing overnight bladder drainage at the Department of Paediatric Surgery, Christian Medical College and Hospital, Vellore between July 2003 and April 2006 were included in this study. From March 2004 onwards the cases were followed prospectively. Children on overnight bladder drainage prior to March 2004 were studied retrospectively with the help of hospital records. Patient inclusion criteria - Children with posterior urethral valves after fulguration, who have - High 24 hours urinary volumes, • Urinary dribbling High post void residual urine, Persistent upper tract dilatation, Pronounced bladder dysfunction, Impaired renal function, Recurrent urinary tract infections, With or without rising Serum Creatinine levels. CONCLUSION : On the basis of our limited experience we believe that nocturnal bladder emptying is safe and may prove to be a preferred alternative to surgical treatment of boys with the valve bladder syndrome as it specifically treats the pathophysiological mechanisms that cause the syndrome. While keeping the bladder as empty as possible during sleep, which lasts for about 10 hours, over distension of bladder is prevented, high pressure overflow incontinence ceases and by eliminating upper tract overfilling hydroureteronephrosis improves. Overnight bladder drainage was well tolerated and was not associated with any significant adverse effects. The therapy for the valve bladder syndrome should be refocused to deal with the combined effects of polyuria, bladder insensitivity and residual urine volume. In our study we found that the age at the time of initiating overnight bladder drainage and the time interval from initial presentation to the initiation of overnight bladder drainage played an important role in determining the ultimate outcome. We are now initiating it in patients at a much younger age, not only to prevent the development of hydroureteronephrosis and the valve bladder syndrome but also to preserve renal function by eliminating bladder over distension. Nocturnal bladder emptying is also ideally suited and currently used for the other causes of impaired bladder emptying especially neurogenic bladder. Preliminary results in this patient population have also been excellent.

Item Type: Thesis (Masters)
Uncontrolled Keywords: Overnight Bladder Drainage ; Children ; Fulgurated Posterior Urethral Valves ; Deteriorating Renal Function ; Bladder Dysfunction.
Subjects: MEDICAL > Paediatric Surgery
Depositing User: Kambaraman B
Date Deposited: 01 Aug 2017 02:14
Last Modified: 01 Aug 2017 02:14

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