Vol. 7, Issue 2, Part A (2025)

Introduction: Bladder outlet obstruction (BOO) in children, often due to posterior urethral valves (PUV), can lead to persistent bladder dysfunction despite primary valve ablation. The role of bladder neck incision (BNI) to address secondary obstruction from a hypertrophic bladder neck remains controversial. This study aimed to evaluate the long-term efficacy of endoscopic treatment, including BNI and/or laser ablation, for pediatric BOO.
Methods: A multi-center retrospective review was conducted on 21 children (mean age 7.84 years) with BOO who underwent endoscopic intervention. Over a mean follow-up of 24 months, outcomes were assessed using serial ultrasound to measure detrusor wall thickness (DWT) and post-void residual (PVR) volume, voiding cystourethrogram (VCUG) for vesicoureteral reflux (VUR), and urinalysis. Pre- and post-intervention parameters were compared using paired statistical tests.
Results: The intervention resulted in highly significant improvements in sonographic parameters (p<0.001). Median DWT decreased from 9.25 mm to 3.58 mm, and median PVR volume reduced from 30.0 mL to 5.0 mL over 18 months. Significant downgrading of VUR was observed in 72.7% of affected patients (p=0.005). Urinalysis revealed highly significant reductions in pyuria (p<0.001) and significant reductions in bacteriuria (p=0.008), indicating fewer urinary tract infections.
Conclusion: Endoscopic treatment of pediatric BOO leads to statistically significant and clinically meaningful improvements in bladder emptying, detrusor hypertrophy, and upper tract decompression. Despite limitations including its retrospective design and lack of a control group, these findings support addressing the bladder neck as a nephroprotective strategy in selected children with refractory BOO. Future prospective, randomized trials are warranted to definitively establish the role of BNI.