Myogenic Failure in Posterior Urethral Valve Disease: Real or Imagined?

No AccessJournal of UrologyPosterior Urethral Valves1 Oct 2002Myogenic Failure in Posterior Urethral Valve Disease: Real or Imagined? Rosalia Misseri, Andrew J. Combs, Mark Horowitz, Jeffrey M. Donohoe, and Kenneth I. Glassberg Rosalia MisseriRosalia Misseri , Andrew J. CombsAndrew J. Combs , Mark HorowitzMark Horowitz , Jeffrey M. DonohoeJeffrey M. Donohoe , and Kenneth I. GlassbergKenneth I. Glassberg View All Author Informationhttps://doi.org/10.1016/S0022-5347(05)64427-8AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract Purpose: It has been suggested that hypocontractility or myogenic failure develops in older boys with a history of 9 posterior urethral valved as the hyperactive, poorly compliant bladders decompensate with age. Also a much higher prevalence of myogenic failure has been reported than we have observed. We determine the prevalence of myogenic failure in boys with a posterior urethral valve and whether myogenic failure was a consequence of earlier detrusor instability or diminished compliance. Materials and Methods: We retrospectively reviewed the urodynamic findings of 51 boys after transurethral ablation of a posterior urethral valve. Group 1 (longitudinal group) consisted of 11 boys 12 to 19 years old who had undergone at least 1 serial urodynamic study before and 1 after age 10 years. Group 2 (younger group) included 33 boys whose urodynamic testing was performed before age 10 years. Group 3 (older group) comprised 7 previously treated boys whose initial urodynamic study was done after age 12 years. Results: Overall, myogenic failure was noted in 3 (all group 1) of 51 (5.9%) patients. Each of the 3 boys initially had a hypocompliant bladder, and myogenic failure developed only after institution of anticholinergic therapy and resolved once anticholinergics were discontinued. An additional 34 boys treated with anticholinergics did not have myogenic failure. No tendency towards myogenic failure or marked increase in bladder capacity for age was noted in the older boys. Conclusions: In our experience myogenic failure is uncommon and more likely secondary to anticholinergic therapy than a preordained consequence of valve disease. We postulate that our proactive, early aggressive use of urodynamic studies and pharmacotherapy to identify and manage the secondary effects of valve disease reduces the incidence of myogenic failure. References 1 : The urodynamic consequences of posterior urethral valves. J Urol1990; 144: 122. Link, Google Scholar 2 : Long term status of patients with posterior urethral valves. Urol Clin N Amer1990; 17: 373. Google Scholar 3 : Early detection of bladder dysfunction following posterior urethral valves. Eur J Pediat Surg1996; 6: 163. 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Google Scholar From the Division of Pediatric Urology, Department of Urology, State University of New York-Downstate Medical Center, Brooklyn, New York© 2002 by American Urological Association, Inc.FiguresReferencesRelatedDetailsCited byAbdelhalim A, El-Hefnawy A, Dawaba M, Bazeed M and Hafez A (2019) Effect of Early Oxybutynin Treatment on Posterior Urethral Valve Outcomes in Infants: A Randomized Controlled TrialJournal of Urology, VOL. 203, NO. 4, (826-831), Online publication date: 1-Apr-2020.Glassberg K and Combs A (2016) The Valve Bladder Syndrome: 35+ Years LaterJournal of Urology, VOL. 196, NO. 1, (16-17), Online publication date: 1-Jul-2016.Casey J, Hagerty J, Maizels M, Chaviano A, Yerkes E, Lindgren B, Kaplan W, Meyer T and Cheng E (2012) Early Administration of Oxybutynin Improves Bladder Function and Clinical Outcomes in Newborns with Posterior Urethral ValvesJournal of Urology, VOL. 188, NO. 4S, (1516-1520), Online publication date: 1-Oct-2012.Tikkinen K, Heikkilä J, Rintala R, Tammela T and Taskinen S (2011) Lower Urinary Tract Symptoms in Adults Treated for Posterior Urethral Valves in Childhood: Matched Cohort StudyJournal of Urology, VOL. 186, NO. 2, (660-666), Online publication date: 1-Aug-2011.Bhandari M and Siva S (2008) Re: The Effects of Bladder Neck Incision on Urodynamic Abnormalities of Children With Posterior Urethral ValvesJournal of Urology, VOL. 179, NO. 6, (2486-2488), Online publication date: 1-Jun-2008.Kajbafzadeh A, Payabvash S and Karimian G (2007) The Effects of Bladder Neck Incision on Urodynamic Abnormalities of Children With Posterior Urethral ValvesJournal of Urology, VOL. 178, NO. 5, (2142-2149), Online publication date: 1-Nov-2007.Canning D (2018) Pediatric UrologyJournal of Urology, VOL. 176, NO. 3, (1184-1186), Online publication date: 1-Sep-2006.Van der Weide M, Cornelissen E, Achterberg T, de Gier R and Feitz W (2018) Lower Urinary Tract Symptoms After Renal Transplantation in ChildrenJournal of Urology, VOL. 175, NO. 1, (297-302), Online publication date: 1-Jan-2006.DONOHOE J, WEINSTEIN R, COMBS A, MISSERI R, HOROWITZ M, SCHULSINGER D and GLASSBERG K (2018) WHEN CAN PERSISTENT HYDROURETERONEPHROSIS IN POSTERIOR URETHRAL VALVE DISEASE BE CONSIDERED RESIDUAL STRETCHING?Journal of Urology, VOL. 172, NO. 2, (706-711), Online publication date: 1-Aug-2004. Volume 168Issue 4 Part 2October 2002Page: 1844-1848 Advertisement Copyright & Permissions© 2002 by American Urological Association, Inc.KeywordsurethraabnormalitiesurodynamicsbladderMetrics Author Information Rosalia Misseri More articles by this author Andrew J. Combs More articles by this author Mark Horowitz More articles by this author Jeffrey M. Donohoe More articles by this author Kenneth I. Glassberg More articles by this author Expand All Advertisement PDF downloadLoading ...