Objective: Posterior urethral valve is one of the most common causes of bladder outflow tract obstruction. Once the posterior urethral valve is diagnosed, it should be resected as early as possible. But bladder dysfunction often occurs after posterior urethral valve (PUV) surgery in children. To study the effect of CIC combined with tolterodine on the recovery of bladder function after PUV surgery, and provide new ideas for clinical treatment.

Methods: 28 children with PUV who underwent cystoscopic posterior urethrotomy in our center from 2016.1-2019.2 were randomly divided into control group (14 cases) and intervention group (14 cases) of CIC combined with tolterodine. The clinical symptoms, imaging and urodynamic examinations were followed up three months after operation, and the improvement of bladder function was compared and analyzed.

Results: Urinary incontinence was found in 7 cases (25.0%), the two groups were 5:2 (35.7% vs 14.3%), urinary tract infection in 5 cases (17.9%), the two groups were 5:0, dysuria 6 cases (21.4%), the two groups were 5:1 (35.7% vs 7.1%), frequent urination 5 cases (17.9%) , the two groups were 5:0, 5 cases (17.9%) without obvious symptoms, and the two groups were 1:4 (7.1% vs 28.6%). Imaging examination showed that 3 cases (10.7%) had posterior urethral dilatation after urethral stricture, compared with 3:0 in the two groups, 11 cases (39.3%) had bladder-ureter reflux, and 8:3 (57.1% vs 21.4%) in the two groups. Urodynamic abnormalities were found in 27 cases (96.4%), Unstable contraction of detrusor in 8 cases (28.6%) , Comparisons between the two groups were 7:1 (50.0% vs 7.1%) and 3 cases (10.7%) with detrusor weakness. Comparisons between the two groups were 1:2 (7.1% vs 14.3%). Residual urine volume increased in 12 cases (42.8%), Comparisons between the two groups were 9:3 (64.3% vs 21.4%) and 11 cases (39.3%) with abdominal pressure assisted urination , the two groups were 9:2 (64.3% vs 14.3%). There were significant differences between the control group and the intervention group (P < 0.05).

Discussions: There were 7 cases of urinary incontinence followed up for 3 months after operation. The control group was significantly higher than the intervention group. The clinical symptoms of recurrent urinary tract infection, urinary exhaustion, urinary frequency and urinary incontinence in the control group were significantly higher than those in the intervention group. There were 5 cases without obvious symptoms, most of which were the intervention group. In the imaging examination, the effect of the intervention group was better than that of the control group. All posterior urethral stricture occurred in the control group. The possible reason was that CIC could dilate the posterior urethra passively, which reduced the incidence of urethral stricture again. So CIC not only excreted residual urine and protected the upper urinary tract, but also reduce the formation of urethral scar, and the occurrence of urethral stricture. Urodynamic examination showed a high incidence of bladder dysfunction after PUV. The detrusor instability contraction occurred in half of the children in the control group. Therefore, combined with tolterodine treatment after operation, inhibiting bladder instability contraction is conducive to improving bladder function, reducing bladder compliance, increasing bladder function capacity, and combining CIC can reduce residual urine volume and protect upper urinary tract. Of course, the incidence of detrusor fatigue after PUV is low, CIC can reduce residual urine, but whether it is suitable for the combination of tolterodine needs further study.

Conclusion: Some children still have clinical symptoms and imaging abnormalities after PUV.  Most children with PUV still have bladder function problems to varying degrees after operation. CIC combined with tolterodine can significantly improve the clinical symptoms after operation and is conducive to the recovery of bladder function. However, long-term follow-up and urodynamic assessment are still needed.