Background Posterior urethral valves (PUV) is the commonest congenital urinary tract anomaly associated with progression to end stage renal disease (ESRD) in children, with bladder dysfunction being a major risk factor. The effect of bladder drainage with intermittent catheterisation on the rate of decline in renal function has not previously been assessed.

Methods A retrospective analysis of changes in the rate of decline in renal function and the degree of hydronephrosis following initiation of bladder drainage was undertaken comparing 10 children undergoing drainage to controls in a single centre cohort of 58 patients with PUV.

Results In the cohort, maximal renal pelvis diameter > 25mm was associated with increased risk of ESRD (p = 0.005). In patients with bladder dysfunction, initiation of bladder drainage was associated with reduction in hydronephrosis (p < 0.001) but no significant reduction in the rate of decline of renal function (p = 0.6).

Conclusions In patients with PUV and bladder dysfunction, initiation of catheter bladder drainage was associated with reduction in hydronephrosis. Whilst no reduction in the rate of decline of renal function was observed in this retrospective analysis, a prospective randomised evaluation of the long-term effect of bladder drainage on renal function is merited.