Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

Management of the valve–bladder syndrome and congenital bladder obstruction: the role of nocturnal bladder drainage

Abstract

Valve–bladder syndrome often develops after the resolution of posterior urethral valves, but is also found after the resolution of congenital bladder obstruction. The features of this syndrome include the persistent dilation of the upper urinary tracts, a thick-walled, noncompliant urinary bladder, urinary incontinence, and polyuria secondary to nephrogenic diabetes insipidus. Nocturnal bladder management, which involves timed emptying of the bladder or continuous drainage, has been recommended in conjunction with diurnal timed voiding therapy as an adjunct to the treatment of valve–bladder syndrome. This treatment is derived from the hypothesis that valve–bladder syndrome is caused by congenital obstruction, and that the resultant changes in detrusor muscle are associated with a persistent bladder dysfunction characterized by chronic overdistention of the urinary bladder. Such overdistention is exacerbated by polyuria, and can be a cause of secondary hydronephrosis. Bladder dysfunction and overdistention is usually treated during waking time, but occasionally this is not effective on its own, and nocturnal therapy is used as well. To date, there are a few sets of data that suggest overnight bladder drainage can bring about profound improvements in the degree of upper-tract hydronephrosis, renal function, or bladder function. Nocturnal bladder drainage seems, in these initial reports, to be a simple and safe therapeutic maneuver. This review discusses the etiology of valve–bladder syndrome and examines each of the studies which have investigated nocturnal bladder drainage in its treatment.

Key Points

  • Transurethral valve ablation is the initial treatment for obstruction caused by PUV, and the vast majority of patients have resolution of hydroureteronephrosis following treatment; however, a small proportion of patients experience persistent hydroureteronephrosis, with some progressing to end-stage renal disease

  • Treatment of valve–bladder syndrome includes anticholinergic drug therapy in combination with timed voiding, utilizing (if needed) intermittent catheterization to empty the bladder

  • Boys with PUV can have a renal concentration defect that leads to large volumes of dilute urine; this arises from obstruction during fetal medullary development that causes a paucity of collecting-duct formation

  • Chronic bladder overdistention at night that is caused by large urine volumes with less frequent bladder emptying is thought to be the cause of persistent upper-tract dilation, despite daytime therapy

  • Despite following a strict daytime regimen of timed voiding and anticholinergic therapy, some boys with valve–bladder syndrome have persistent hydroureteronephrosis, which can be alleviated by a strict nocturnal voiding regimen

  • Nocturnal bladder drainage by timed voiding or either intermittent or indwelling catheterization has been shown to alleviate the symptoms of valve–bladder syndrome and might slow down the progression to renal failure

This is a preview of subscription content, access via your institution

Relevant articles

Open Access articles citing this article.

Access options

Buy article

Get time limited or full article access on ReadCube.

$32.00

All prices are NET prices.

References

  1. Mitchell ME (1982) Persistent ureteral dilation following valve resection. Dial Pediatr Urol 5: 8

    Google Scholar 

  2. Casale AJ (1990) Early ureteral surgery for posterior urethral valve. Urol Clin North Am 17: 361–372

    CAS  PubMed  Google Scholar 

  3. Churchill BM et al. (1990) Emergency treatment and long term follow-up of posterior urethral valves. Urol Clin North Am 17: 343–360

    CAS  PubMed  Google Scholar 

  4. Holmdahl G and Sillen U (2005) Boys with posterior urethral valves: Outcomes concerning renal function, bladder function, and paternity at ages 31 to 44 years. J Urol 174: 1031–1034

    Article  Google Scholar 

  5. Whitaker RH (1973) The ureter in posterior urethral valves. Br J Urol 45: 395–403

    Article  CAS  Google Scholar 

  6. Kim KM et al. (1991) Collagen and elastin in the obstructed fetal bladder. J Urol 146: 528–531

    Article  CAS  Google Scholar 

  7. Koo HP et al. (1997) Developmental expression of interstitial collagen genes in fetal bladders. J Urol 158: 954–961

    Article  CAS  Google Scholar 

  8. Peters CA et al. (1992) The effect of obstruction on the developing bladder. J Urol 148: 491–496

    Article  CAS  Google Scholar 

  9. Peters CA et al. (1990) The urodynamic consequences of posterior urethral valves. J Urol 144: 122–126

    Article  CAS  Google Scholar 

  10. Parkhouse HF and Woodhouse CR (1990) Long-term status of patients with posterior urethral valves. Urol Clin North Am 17: 373–378

    CAS  PubMed  Google Scholar 

  11. Kim YH et al. (1997) Management of posterior urethral valves on the basis of urodynamic findings. J Urol 158: 1011–1016

    Article  CAS  Google Scholar 

  12. Glassberg KI et al. (1982) Observations on persistently dilated ureter after posterior urethral valve ablation. Urology 20: 20–28

    Article  CAS  Google Scholar 

  13. Duckett JW (1997) Are 'valve bladders' congenital or iatrogenic? Br J Urol 79: 271–275

    Article  CAS  Google Scholar 

  14. Koff SA et al. (2002) The valve bladder syndrome: pathophysiology and treatment with nocturnal bladder emptying. J Urol 167: 291–297

    Article  Google Scholar 

  15. Montane B et al. (2003) Beneficial effects of continuous overnight catheter drainage in children with polyuric renal failure. BJU Int 92: 447–451

    Article  CAS  Google Scholar 

  16. Nguyen MT et al. (2005) Overnight catheter drainage in children with poorly compliant bladders improves post-obstructive diuresis and urinary incontinence. J Urol 174: 1633–1636

    Article  Google Scholar 

  17. Lapides J et al. (1972) Clean intermittent self-catheterization in the treatment of urinary tract disease. J Urol 107: 458–461

    Article  CAS  Google Scholar 

  18. Duckett JW and Snyder HM (1987) The Mitrofanoff principle in continent urinary reservoirs. Semin Urol 5: 55–62

    CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Gordon A McLorie.

Ethics declarations

Competing interests

The authors declare no competing financial interests.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Fumo, M., McLorie, G. Management of the valve–bladder syndrome and congenital bladder obstruction: the role of nocturnal bladder drainage. Nat Rev Urol 3, 323–326 (2006). https://doi.org/10.1038/ncpuro0507

Download citation

  • Received:

  • Accepted:

  • Issue Date:

  • DOI: https://doi.org/10.1038/ncpuro0507

This article is cited by

Search

Quick links

Nature Briefing

Sign up for the Nature Briefing newsletter — what matters in science, free to your inbox daily.

Get the most important science stories of the day, free in your inbox. Sign up for Nature Briefing