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OBJECTIVE: To assess whether tamsulosin may aid emptying of the lower urinary tract in posterior urethral valves (PUV) patients, mitigating the likelihood of progressing to clean intermittent catheterization (CIC) or need for renal replacement therapy.
METHODS: We reviewed a prospective institutional database containing PUV patients treated between January 2000-January 2022. After assessing baseline characteristics, Kaplan-Meier survival curves and log-rank tests were generated to assess differences in clinically significant outcomes (progression to CIC, dialysis, or kidney transplantation) between those prescribed tamsulosin and those who were not.
RESULTS: A total of 179 patients were included. Fifty-nine patients received tamsulosin prior to initiation of CIC (Group 1), and 120 did not (Group 2). The baseline characteristics were similar between the two groups, except for anticholinergic use (tamsulosin group - 35/59 vs. no tamsulosin - 32/120, p<0.001). The median age at tamsulosin initiation was 26.0 months (IQR 15.5-48.6) and the median time from initiation of tamsulosin to progression to CIC was 52.6 months (IQR 10.1-69.3). Kaplan-Meier survival curves showed that patients on tamsulosin were less likely to progress to CIC (p=0.021), however, there was no difference in progression to dialysis or kidney transplantation. A Cox-regression analysis controlling for baseline characteristics, including age, anticholinergic use, VUR severity, and CKD stage at 1-year of life, showed a consistent effect of tamsulosin in delaying progression to CIC (HR 0.444 95%CI 0.218-0.902, p=0.025).
CONCLUSION: While tamsulosin may delay CIC, it does not appear to delay progression to end-stage renal disease. Additional studies exploring specific patient factors are required to determine the timing and subset who may benefit the most from tamsulosin.