Concomitant Bladder Neck Incision in Patients with Posterior Urethral Valve and Blad-der Neck Hypertrophy: Short-term Outcomes of a Randomized Controlled Trial.

INTRODUCTION

Concomitant bladder neck incision (BNI) with posterior urethral valve ablation (VA) was proposed to mitigate the long-term sequela of posterior urethral valve (PUV) and reduce the reoperation rates. This study aimed to investigate the short-term outcomes of concomitant BNI and VA, particularly short-term reoperation rates.

PATIENTS AND

METHODS

Patients with PUV and bladder neck hypertrophy on preoperative imaging were randomized to undergo VA only or VA with concomitant BNI. Surgical reoperation within one year was the primary endpoint. Renal function, UTI, hydronephrosis and VUR improvement at one year were secondary endpoints.

RESULTS

Sixty-three patients were included in the final analysis, 33 in VA group (group A) and 30 in concomitant BNI and VA group (group B). After one year of follow-up, the reoperation rate was similar [5(15.2%) in group A and 3(10%) in group B, p=0.18]. The median (IQR) nadir serum creatinine was lower in group B [0.2 (0.1-0.3) vs. 0.2 (0.2-0.4) mg/dL in group A, p=0.049]. The last follow-up serum creatinine median (IQR) eGFR [107 (89.5-163) in group A vs. 139(102-165) mL/min/1.73 m2 in groups B, p=0.37], and febrile UTI rates were not different between the two groups. Hydronephrosis improved/ resolved in 27 (40.9%) renal units in group A vs. 33 (55%) renal units in group B (p=0.286). Vesicoureteral reflux improved/ resolved in 23(34.8%) and 12 (20%) renal units in group A and B, respectively (p=0.074).

CONCLUSION

Concomitant BNI with VA does not confer a lower short-term reoperation rate or better upper urinary tract outcomes compared to VA only.