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Impact of Urodynamic Testing in the First Year of Life on Management of Posterior Urethral Valve
Paul Smith, III, MD, Sara Valente, MD, Abdulkadir Izci, BS, Katherine W. Herbst, MS, Melinda Carpenter, MS, Miriam Harel, MD
Connecticut Children's Medical Center, Hartford, CT

BACKGROUND: Abnormal and often hostile bladder function is well documented in patients with posterior urethral valve (PUV). Early management of the lower urinary tract is considered a critical component in the management of these patients to prevent ongoing renal injury during a time of rapid renal development. However, optimal timing for assessment of the lower urinary tract with urodynamics in patients with PUV remains unclear. We report the impact of urodynamic testing in the first year of life on clinical management in patients with PUV at our center.
METHODS: At our institution, initial urodynamic testing is routinely performed within the first year of life for patients with PUV. A retrospective review was performed for patients with PUV undergoing initial urodynamic evaluation within the first year of life between 2007 and 2015. Urodynamic findings were documented, including bladder capacity, compliance, detrusor overactivity, voiding pattern, postvoid residual volume, and fluoroscopic findings. Clinical decision making based on urodynamic findings was assessed by review of clinician notes.
RESULTS: After excluding patients with complicating factors or without one-year follow-up data, nine patients with PUV (Table) were identified who underwent initial urodynamic testing within the first year of life at a mean age of 5.8 months (SD ± 3.15). Urodynamic findings were notable for detrusor overactivity in six patients, impaired bladder capacity in one patient, and a non-compliant bladder in one patient. No patients were observed to have an elevated post-void residual volume. Anticholinergic medication was started in three patients due to urodynamic findings of high amplitude detrusor overactivity, impaired compliance, and small capacity bladder. The remaining six patients were recommended for continued clinical and radiographic surveillance. No other pharmaceutical or surgical interventions were prompted by urodynamic findings.
CONCLUSIONS: Establishing a safe lower urinary tract is a critical element in management of PUV. Routine use of early urodynamic evaluation is useful in defining the baseline lower urinary tract function in patients with PUV. Despite our limited sample size, we observed that clinical management changed as the result of findings on early urodynamic evaluation in nearly one-third of patients.


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