COMPARATIVE URODYNAMIC FINDINGS AFTER PRIMARY VALVE ABLATION, VESICOSTOMY OR PROXIMAL DIVERSION

Purpose: There is little known about the effect of urinary diversion o n the bladder of children with posterior urethral valves. There is a f ear that diversion may result in contracted noncompliant bladders. We wished to compare urodynamic parameters in patients who underwent prim ary ablation of posterior urethral valves and in those who underwent d iversion in the form of vesicostomy or pyelostomy. Materials and Metho ds: Urodynamics were done in 32 boys with a history of posterior ureth ral valves divided into 3 groups based on initial treatment: 1) transu rethral valve ablation; 2) cutaneous vesicostomy, subsequent closure a nd valve ablation, and 3) proximal cutaneous pyelostomy, subsequent re constitution and valve ablation. Results: Patients who underwent initi al diversion with vesicostomy or pyelostomy had bladders with larger f unctional capacity, better compliance and less instability. Chronic re nal failure developed in 25% of the patients who underwent primary val ve ablation and 33% of those who underwent diversion. Average period o f diversion in vesicostomy and pyelostomy patients was 25 months. Conc lusions: Based on our findings temporary diversion does not seem to da mage bladders. On the contrary, placing a damaged bladder at rest may help to improve bladder function. Bladder function following reconstit ution correlated poorly with ultimate outcome and progression to renal failure. While we do not recommend temporary diversion as the treatme nt of choice for patients with posterior urethral valves, we believe t hat when chosen as treatment, it can be safely performed with little r isk of further damage to the bladder.