This study assessed the impact of overnight bladder drainage (OBD) via catheterization on boys with persistent hydronephrosis (HN) following posterior urethral valve (PUV) ablation. In this randomized controlled trial, boys with HN at least one year post-PUV ablation were divided into two groups: an OBD group, which involved catheter placement for 8–12 hours each night, and a non-OBD group. Patients with prior urinary diversions, infravesical obstruction, or those who declined participation were excluded. Both groups were advised on timed voiding every three hours and received anticholinergics and antibiotic prophylaxis. After a 12-month follow-up, assessments included compliance with OBD, daytime continence, occurrence of febrile urinary tract infections (UTIs), renal function (via serum creatinine and DMSA scan), HN and vesicoureteral reflux (VUR) improvement, and bladder morphology evaluated by renal and bladder ultrasound, as well as voiding cystourethrogram.
Out of 106 participants (54 in the OBD group and 52 in the control group), 47 in the OBD group maintained compliance and were included in the final analysis. The OBD group demonstrated significant improvements in HN, VUR, bladder capacity, and bladder outline compared to the control group. Daytime dryness was also notably higher in the OBD group, with 63.8% achieving over three hours of dryness compared to 44.2% in the control group (p=0.04). However, there were no significant differences between the groups regarding febrile UTIs, renal function as indicated by serum creatinine and DMSA scan, bladder wall thickness, or post-void residual urine. These findings suggest that OBD may benefit patients by enhancing bladder function and morphology without compromising renal function or increasing UTI risk, though patient compliance remains a challenge.
