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Bladder Neck Obstruction In Boys with Valve Bladder Syndrome; Fact or Fiction?

Saturday, October 20, 2012
Grand Ballroom A/B (Hilton Riverside)
Mohamed Youssif, MD, Ibrahim Mokhless, MD, M. Yehia, MD and A. Zahran, MD, Pediatric Urology Section, Urology Department, Alexandria University, Egypt, Alexandria University, Alexandria, Egypt

Purpose Valve bladder syndrome (VBS) represents the worst end of posterior urethral valve (PUV) spectrum. The role of bladder neck hypertrophy with subsequent obstruction remains debatable as a possible contributing factor in the pathogenesis of this syndrome. We conducted a prospective randomized study to determine if bladder neck obstruction is implicated in the pathogenesis of valve bladder syndrome or not.


Twenty boys with valve bladder syndrome were studied. All patients had primary endoscopic valve ablation. Patients were randomized into 2 groups. Group I (study group) including 10 boys where in addition to the standard conservative treatment (suppressive therapy, anticholinergic, CIC and overnight catheter indwelling) had endoscopic injection of a single dose of 100 I.U of Botox into the hypertrophied bladder neck at 3, 6, 9 o`clock position. Group II (control group) including 10 boys where urethroscopy was performed to exclude residual valves in addition to the standard conservative treatment.  Preoperative evaluation & follow up were performed at 1, 3, and 6 months by laboratory studies (urine culture and sensitivity, BUN, serum creatinine), ultrasound of the urinary tract, VCUG and urodynamics (pressure flow study).

Results The mean age of the boys was 17 months. There was no statistical difference in both groups regarding rate of febrile UTI, improvement of hydronephrosis, resolution of VUR, creatinine level at the start or at the end of the study. Urodynamic parameters revealed significant increase in cystometric capacity in group I without statistical difference between both groups (mean capacity increased from 117 cc to 151 cc in the study group and from 113 cc to 179 cc in the control group). The mean voiding pressure reduced significantly in both groups but without statistical difference  (from 85.20 ± 21 cmH2O to 70.70 ± 23 cmH2O in the study group and from 76.0 ± 17 cmH2O to 65.40 ± 14 cmH2O in the control group).

Conclusion Abolishing the presumed obstructing effect of bladder neck by Botox injection does not seem to improve the outcome of valve bladders. This study is another proof that   the role of bladder neck obstruction in boys with valve bladder syndrome does not exist and has no functional implication in its pathophysiology. Thus role of bladder neck incision should be cautiously evaluated.