The fate of the bladder in patients with congenital infravesical obstruction

Current Opinion in Urology

Volumn 7, Issue 6, 1997, Pages 325-330

  Baskin, Laurence S ^a  

^a UNIVERSITY OF CALIFORNIA   (United States)

Author keywords

[No Author keywords available]

Indexed keywords

BLADDER FUNCTION; BLADDER RECONSTRUCTION; CONTINENCE; HUMAN; PRIORITY JOURNAL; REVIEW; URETHRA VALVE; URINARY DIVERSION; URINARY TRACT OBSTRUCTION;

EID: 0030729649     PISSN: 09630643     EISSN: None     Source Type: Journal    
DOI: 10.1097/00042307-199711000-00003     Document Type: Review

References (19)

1. Smith GH, Canning DA, Schulman SL, Snyder HMIII, Duckett JW: The long-term outcome of posterior urethral valves treated with primary valve ablation and observation. J Urol 1996, 155:1730-1734. This is an excellent 20-year retrospective review of 100 patients treated for posterior urethral valves at the Children's Hospital of Philadelphia. Kaplan Meir analysis revealed no difference in the incidence of end-stage renal disease between patients treated by high diversion versus those treated by primary vesicostomy and primary valve ablation. Bladder function in patients with posterior urethral valves was clearly abnormal, with approximately 50% of the group having daytime incontinence at 10 years of age. Continence improved with time, with only one patient having daytime wetting issues at 20 years of age. The authors conclude that, by avoiding diversion in most cases, bladder function is preserved and the need for bladder augmentation is decreased.
2. Dewan PA: Type III posterior urethral valves: presentation and management [Letter]. J Pediatr Surg 1996, 31:867.
3. Dinneen MD, Duffy PG: Posterior urethral valves. Br J Urol 1996, 78:275-281.
4. Denes ED, Barthold JS, Gonzalez R: Early prognostic value of serum creatinine levels In children with posterior urethral valves. J Urol 1997, 157:1441-1443.
5. Duckett JW: Are 'valve bladders' congenital or iatrogenic? Br J Urol 1997, 79:271-275. The author elegantly argues that the valve bladder is iatrogenic from high urinary diversion which prevents normal bladder cycling and development.
6. Close CE, Carr MC, Burns MW, Mitchell ME: Lower urinary tract changes after early valve ablation in neonates and infants: is early diversion warranted? J Urol 1997, 157:984-988. The authors retrospectively review their experience with primary valve ablation versus early diversion in patients with posterior urethral valves. Their data support the conclusion that early ablation of posterior urethral valves results in the recovery of normal bladder appearance and function when performed in the first months of life. Severe renal insufficiency tends to progress even with upper tract diversion. Furthermore, high diversion prevents normal bladder cycling, which may inhibit bladder recovery in patients with posterior urethral valves.
7. Greenfield SP: Posterior urethral valves - new concepts [Editorial]. J Urol 1997, 157:996-997.
8. Mitchell ME, Close CE: Early primary valve ablation for posterior urethral valves. Semin Pediatr Surg 1996, 5:66-71. The authors review their experience with early valve ablation, advocating that the damaged bladder and upper tracts have the potential to heal if the obstruction is removed and the bladder is allowed to fill and empty cyclically in the first few months of life. The renal insufficiency associated with valves is often secondary to primary renal dysplasia. with many patients progressing to renal failure and transplantation. The authors' experience is that upper tract diversion has failed to improve long-term outcome in patients with renal dysplasia; furthermore, it jeopardizes the potential for bladder healing and normal bladder function.
9. Pfister C, Wagner L, Dacher JN, Liard A, Boillot B, Mitrofanoff P: Long-term bladder dysfunction in boys with posterior urethral valves. Eur J Pediatr Surg 1996, 6:222-224. Long-term follow-up of patients with posterior urethral valves showed no cases of detrusor sphincteric dyssynergy or urethral hypotony. Over time, the majority of patients gained urinary continence.
10. Holmdahl G, Sillen U, Hanson E, Hermansson G, Hjalmas K: Bladder dysfunction in boys with posterior urethral valves before and after puberty. J Urol 1996, 155:694-698. Serial longitudinal urodynamics were performed in patients with posterior urethral valves. Patients had a changing urodynamic pattern over time, with decreasing instability, increasing bladder capacity, and commonly an unsustained voiding contraction causing emptying difficulties. Post-pubertal boys had high-capacity bladders with low contractility. The authors conclude that the previously described urodynamic patterns of the valve bladder (unstable, poorly compliant and over-distended bladders) are variations of the same basic pattern that changes with time toward decompensation.
11. Salomon L, Fontaine E, Gagnadoux MF, Broyer M, Beurton D: Posterior urethral valves: long-term renal function consequences after transplantation. J Urol 1997, 157:992-995. The 10-year outcome of renal transplantation in patients with posterior urethral valves was compared with that in a similar group of patients without valves. Graft survival was not different between the two groups; however, at 10 years after transplant, patients with posterior urethral valves had a statistically significant decrease in renal function, implying that the abnormal valve bladder was a risk factor for renal insufficiency.
12. De Gennaro M, Mosiello G, Capitanucci ML, Silveri M, Capozza N, Caione P: Early detection of bladder dysfunction following posterior urethral valves ablation. Eur J Pediatr Surg 1996, 6:163-165.
13. Baskin LS, Hayward SW, Young P, Cunha GR: Role of mesenchymal-epithelial interactions in normal bladder development. J Urol 1996, 156:1820-1827. This experimental paper shows that cellular communication exists between bladder urothelium and bladder mesenchyme, and that this communication is necessary for the development of bladder smooth muscle.
14. Baskin LS. Hayward SW, Young PF, Cunha GR: Ontogeny of the rat bladder: smooth muscle and epithelial differentiation. Acta Anat (Basel) 1996, 155:163-171. During normal bladder development, smooth muscle and urothelium go through a sequential process of differentiation. This paper describes the ontogeny of smooth muscle and epithelial differentiation markers as the bladder develops from undifferentiated endoderm and mesenchyme into mature urothelium and smooth muscle.
15. Baskin LS, Hayward SW, Sutherland RA, DiSandro MJ, Thomson AA, Goodman J. Cunha GR: Mesenchymal epithelial interactions in the bladder. World J Urol 1996, 14:301-309.
16. Baskin LS, Sutherland RS, Thomson AA, Hayward SW, Cunha GR: Growth factors and receptors in bladder development and obstruction. Lab Invest 1996, 75:157-166. This paper describes the ontogeny of transforming growth factors α and β and KGF and their receptors in normal bladder development and obstruction.
17. Sutherland RS, Baskin LB, Elfman F, Cunha GR: The role of type IV collagenases in rat bladder development and obstruction. Pediatr Res 1997, 41:430-434. Extracellular matrix remodeling is a normal process during bladder development and a response to stress such as bladder outlet obstruction. This paper reviews the ontogeny of tissue matrix metalloproteinases (type IV collagenases, MMP2 and MMP9) during bladder remodeling events. Regulation of these degradative proteins may prove useful in treating bladder dysfunction.
18. Baskin L, Sutherland R, Thomson A, Nguyen H, Morgan D, Hayward S, Horn Y, DiSandro M, Cunha GR: Growth factors in bladder wound healing. J Urol 1997, 157:2388-2395. In an animal model of bladder wound healing, the authors have shown that KGF acts in a paracrine fashion causing urothelial proliferation to repair bladder injury. KGF is synthesized in the stromal bladder compartment and acts on the KGF receptors which are localized to the urothelium.
19. Sutherland RS, Baskin LS, Hayward SW, Cunha GR: Regeneration of bladder urothelium, smooth muscle, blood vessels and nerves into an acellular tissue matrix. J Urol 1996, 156:571-577. In a model of bladder regeneration using an acellular matrix tissue patch for bladder replacement, the biology of bladder cell growth was studied. Native urothelium completely lined the matrix by 4 days. Smooth muscle cells grew into the matrix patch by 2 weeks and over time organized into smooth muscle bundles. Interestingly, the smooth muscle cells seemed to grow adjacent to the urothelium, suggesting that the urothelium has an inductive capability.