Posterior urethral valve and chronic constipation: Association and clinical outcome following endoscopic ablation in children

Abstract Objectives Posterior urethral valves (PUV) are the most common cause of congenital urinary obstruction in male infants and may be associated with lower urinary tract symptoms (LUTS). The association between LUTS and chronic constipation (CC) in children, known as bladder and bowel dysfunction (BBD), has been extensively investigated. However, how primary urological obstruction may influence gastrointestinal function remains poorly investigated. This study aimed to assess the prevalence of CC in children with PUV and evaluate changes in bowel symptoms following endoscopic PUV ablation. Methods We conducted a prospective observational study at “Santobono‐Pausilipon Children's Hospital” in Naples, Italy, from January 2021 to March 2024. Patients aged 0–6 years with PUV were enrolled. Demographic and clinical data were collected, including age, valve type, urological signs and symptoms, comorbidities, ongoing therapies. Bowel habits were assessed at diagnosis and after PUV ablation using Rome IV criteria. Results One hundred and one children were enrolled (mean age ± standard deviation = 32 ± 48.4 months). At baseline, 27/101 (26.7%) met Rome IV criteria for CC. After PUV ablation, constipation resolved in 19/27 patients ( p < 0.01), reducing overall constipation prevalence from 26.7% to 11.9% ( p < 0.01). Multivariate analysis did not identify predictors of constipation resolution. Conclusions Children affected by PUV exhibit a likely increased prevalence of CC. Endoscopic PUV ablation leads to significant normalization of bowel function, supporting a bidirectional interplay between urinary and gastrointestinal systems. Larger controlled studies are needed to confirm these findings in order to clarify the underlying mechanisms and optimize long‐term care for affected patients.