Efficacy and Tolerability of Overnight Bladder Drainage post Posterior Urethral Valve Ablation on Upper and Lower Urinary Tracts: A Randomized Controlled Trial.

Abstract

To study the effect of overnight bladder drainage (OBD) on upper and lower urinary tracts of boys post endoscopic valve ablation (EVA). In a randomized controlled trial, boys who had persistent hydronephrosis (HN) and unfavorable bladder dynamics after EVA were included. Those who underwent urinary diversion, had residual obstruction or refused to participate were excluded. Patients were randomly allocated into OBD or no OBD groups. Timed voiding, anticholinergics and antibiotic prophylaxis were offered for all patients. After 12 months, patients were evaluated for HN, vesicoureteral reflux (VUR), renal parenchymal area, bladder morphology and dynamics by renal and bladder ultrasound, voiding cystourethrogram and urodynamic study, daytime continence, nocturnal polyuria, renal function, renal scarring by ^99mTc-dimercaptosuccinic acid scan, febrile urinary tract infections (UTIs) and tolerability to OBD. A total of 99 patients, 47 patients had OBD and 52 patients had no OBD, were included between September 2021 and August 2023. OBD showed significant improvement in HN, VUR, renal parenchymal area, bladder capacity, outline, detrusor overactivity, compliance, daytime continence and nocturnal polyuria. However, no significant difference was noted regarding bladder wall thickness, post-void residual urine, bladder sensation, detrusor leak point pressure, maximum flow rate, flow curve morphology, renal function, renal scarring and febrile UTIs. Tolerability to OBD was reported in 87%. OBD, apart from patients' tolerability, improves HN, VUR, renal parenchymal growth, abnormal bladder morphology and dynamics, daytime continence and nocturnal polyuria that persist after EVA with no consequent renal function affection or febrile UTIs.