Bladder Neck Incision in Posterior Urethral Valve Management: a Meta-Analysis with Insights into Adjunctive Bladder Interventions

Abstract

To evaluate the outcomes of bladder neck incision (BNI) and alternative treatments, such as alpha blockers, in improving voiding dysfunction in posterior urethral valve (PUV) after valve ablation (VA). Eleven studies comprising 826 patients with PUV were included. Concomitant BNI and VA significantly improved both VUR resolution (Risk Ratio “RR”= 1.36; 95% CI: 1.04–1.79), and postoperative serum creatinine -0.16 (95% CI: -0.28 to -0.04). Concomitant BNI and VA significantly improved detrusor overactivity (RR = 0.44; 95% CI: 0.22–0.91; p = 0.03), and reduced significantly maximum detrusor pressure at Qmax (Pdetmax) by-23.53 (95% CI: -35.01 to -12.05). It also significantly decreased both the use of alpha blocker/anticholinergic (RR = 0.59; 95% CI: 0.36 to 0.95), and the need for intermittent catheterization (RR = 0.16; 95% CI: 0.03 to 0.83; p = 0.03). However, there were no significant difference either in bladder compliance (RR = 0.75; 95% CI: 0.31 to 1.79), nor children required re-intervention (RR = 0.52; 95% CI: 0.25 to 1.05). Alpha blockers after VA showed a pooled post-void residual urine reduction of -59.44 (95% CI: -129.05 to 10.17). The pooled estimate for peak flow rate with alpha blockers was 14.22 (95% CI: 13.70–14.74). BNI combined with valve ablation could improves bladder function and reduces the need for additional interventions compared to VA alone.