الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
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Abstract
Introduction and review of literature: Posterior urethral valve (PUV) is considered one of the most common urological congenital anomalies in boys. PUV may lead to persistent hydronephrosis (HN) and unfavorable bladder dynamics even after successful endoscopic PUV ablation. Aim of the work: We evaluated the effect of overnight bladder drainage (OBD) using catheter on the upper urinary tracts and bladders of boys post PUV ablation. Patients and Methods: In a randomized controlled trial, boys who had persistent HN and unfavorable bladder dynamics at least one year after endoscopic valve ablation were included. Those who underwent urinary diversion, maintained on clean intermittent catheterization (CIC), had infravesical obstruction or refused to participate were excluded. Patients were randomly allocated into either OBD (catheter placement in the bladder for 8-12 hours every night) or no OBD groups. Timed voiding every 3 hours, anticholinergics drugs and antibiotic prophylaxis were offered for patients in both groups. After 12 months of starting treatment, patients were evaluated for compliance to treatment, body weights and heights, daytime urinary continence (>3 hours dry), febrile urinary tract infections (UTIs), nighttime urine production, urine density and osmolality, renal function evaluation by serum creatinine (SCr) and estimated glomerular filtration rate (eGFR), improvement in HN, vesicoureteral reflux (VUR), renal parenchymal thickness (PT) and area, bladder wall thickness, post-void urine residual (PVR) and lower end ureter dilation by bladder ultrasound (US), bladder capacity and outline by voiding cystourethrogram (VCUG), renal scarring by 99mTc-dimercaptosuccinic acid (DMSA) scan and bladder function by cystometrogram and uroflowmerty. Results: A total of 99 patients; 47 underwent OBD while the remaining 52 had no OBD, were included and completed 12 months of follow-up between August 2021 and September 2023. Compliance to OBD was only reported in 87.04%, those who were included in analysis. Daytime continence in toilet-trained children was more significantly noted in the OBD patients (62.8% vs. 44.4%, p=0.04). Nocturnal polyuria also showed significant improvement in the treatment group (46.8% vs. 21.2%, p=0.02). No significant difference was found between both groups regarding body weights and heights, febrile UTIs or renal function affection estimated by SCr and eGFR. There was significant improvement in HN, VUR, renal PT and area, lower end ureter dilation, bladder capacity and outline in the OBD group. Cystometrogram also showed significant improvement in terms of detrusor overactivity (DO), bladder compliance and capacity in the treatment group. However, bladder wall thickness and PVR assessed by bladder US, renal scarring and split renal function (SRF) estimated by 99mTc-DMSA scan and maximum flow rate and flow curve morphology evaluated by uroflowmetry were comparable between both groups. Conclusion: we concluded that OBD might improve daytime continence, nocturnal polyuria, HN, VUR, renal parenchymal growth, abnormal bladder morphology and dynamics that persist after endoscopic valve ablation with no subsequent increase in febrile UTIs or renal function affection. Yet, compliance to OBD remains a matter of concern. Recommendations: We recommend that further studies need to be conducted with long-term follow-up to evaluate the long-term effect of OBD on the upper urinary tracts and bladders of boys post PUV ablation.