title: Efficacy and safety of urethral de-obstruction in boys with overactive bladder complaints.
abstract: OBJECTIVE
  To gain insight into the efficacy and safety of urethral de-obstruction in boys with overactive bladder (OAB) complaints refractory to conservative treatment.
  
  
  METHODS
  All boys, older than 5 years, referred in 2009 for OAB complaints were included, n = 180. Nine had abdominal or penile pain as predominant complaint. 82% were tertiary referrals after unsuccessful conservative treatment with antimuscarinic medication and/or urotherapy for OAB. In 121, urethral obstruction was urodynamically proven or seriously suspected, and they underwent urethrocystoscopy with relief of obstruction, when present. Average duration of unsuccessful conservative pre-treatment in this group of patients was 1.2 years. Postoperative results, in terms of relief of complaints, were analyzed. Safety was assessed by analyzing those patients who had a secondary transurethral procedure in the same year, or in the 3 years after primary treatment.
  
  
  RESULTS
  Of 106 boys with OAB, urge incontinence or therapy-resistant bedwetting, after de-obstruction 33 became free of complaints and 39 showed significant improvement, totaling 72 (68%); dry after additional urotherapy 11 (10%); no change 21 (20%). Nine boys had de-obstruction because of penile or abdominal pain, with 5 completely cured after the procedure. Follow-up treatment was cognitive training in 39, temporary anticholinergic treatment in 26 and CIC in 2 cases. Recurrence of obstruction was seen in 10% during the 3-year follow-up period.
  
  
  CONCLUSIONS
  After failure of conservative therapy, one should actively look for any urethral obstruction as underlying cause of OAB. For such patients, urethral de-obstruction is highly effective, with only a few minor late complications resulting in recurrence of obstruction.
authors.affiliation: Pediatric Renal Center, University Children's Hospitals UMC Utrecht and AMC Amsterdam, The Netherlands. Electronic address: t.p.v.m.dejong@umcutrecht.nl.
authors.forename: Tom P V M
authors.initials: TP
authors.lastname: de Jong
authors.forename: Caroline F
authors.initials: CF
authors.lastname: Kuijper
authors.forename: Rafal
authors.initials: R
authors.lastname: Chrzan
authors.forename: Pieter
authors.initials: P
authors.lastname: Dik
authors.forename: Aart J
authors.initials: AJ
authors.lastname: Klijn
authors.forename: Marianne A
authors.initials: MA
authors.lastname: Vijverberg
mesh_terms: D015746:Abdominal Pain / Q000188:drug therapy / Q000209:etiology / Q000601:surgery; D002648:Child; D002675:Child, Preschool; D006801:Humans; D008297:Male; D018727:Muscarinic Antagonists / Q000627:therapeutic use; D053206:Nocturnal Enuresis / Q000188:drug therapy / Q000209:etiology / Q000601:surgery; D012189:Retrospective Studies; D016896:Treatment Outcome; D014521:Urethra / Q000601:surgery*; D014524:Urethral Obstruction / Q000150:complications* / Q000601:surgery*; D053201:Urinary Bladder, Overactive / Q000188:drug therapy / Q000209:etiology* / Q000601:surgery*; D053202:Urinary Incontinence, Urge / Q000188:drug therapy / Q000209:etiology / Q000601:surgery; D013521:Urologic Surgical Procedures, Male / Q000379:methods*
chemical_list: D018727:Muscarinic Antagonists
keywords: Incontinence; Overactive bladder; Posterior urethral valves