Toilet training achievements in children born with posterior urethral valves.

Abstract

Boys born with posterior urethral valves (PUV) often experience bladder development issues due to urethral obstruction during gestation. Despite early surgical intervention, bladder dysfunction can persist, leading to detrusor overactivity and vesical overdistension. Successful toilet training is key in managing bladder function and controlling intravesical and upper urinary tract pressures. This study aims to evaluate toilet training outcomes in children with PUV. This single-centre ambispective cohort study included 142 children aged 4 years and older who underwent PUV ablation between January 2003 and December 2021. The patients were categorised into two groups: those with cognitive comorbidities (group A), including autism spectrum disorder, attention deficit hyperactivity disorder and trisomy 21, and those without (group B). Among the 142 children, 128 (90.1%) achieved daytime continence at a median age of 37 months (range 33-49 months) and 115 (81.0%) attained night-time continence at a median age of 42 months (range 34-60 months). Children in group A showed significantly lower rates of continence compared with group B (daytime: 74.2% vs 94.6%, p=0.0026; night-time: 67.7% vs 84.7%, p=0.0412). Additionally, children in group A completed toilet training significantly later than those in group B (daytime: 64 vs 36 months, p=0.0002; night-time: 60 vs 42 months, p=0.0139). Boys with PUV can achieve daytime and night-time continence at ages comparable to those reported by their peers; the presence of cognitive comorbidities is associated with delays in achieving these milestones.