Long-term sexual function, fertility, and quality of life after childhood treatment for posterior urethral valves: a systematic review of clinical outcomes

INTRODUCTION: Posterior urethral valves are the leading cause of congenital bladder outlet obstruction in boys and can result in long-term lower urinary tract dysfunction and reduced quality of life. Sexual and reproductive consequences in this population are poorly described and understood. OBJECTIVES: The purpose of this systematic review (SR) was to assess the long-term sexual functions and fertility outcomes in patients treated in the pediatric age for posterior urethral valve (PUV). METHODS: A SR was conducted following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. MEDLINE, Embase, and Scopus were searched for studies reporting sexual or reproductive outcomes in individuals with a history of PUV. The primary outcomes were prevalence and nature of sexual dysfunctions and fertility issues. Risk of bias was assessed using ROBINS-I or the Newcastle-Ottawa Scale, as appropriate. RESULTS: Eleven studies (2 non-randomized comparative studies and 9 case series) including 2723 individuals met the inclusion criteria. Most patients exhibited preserved erectile function, ejaculatory function was variably reported with most individuals described normal ejaculation. Semen analysis, reported in 7 studies, revealed normal parameters in approximately half of the cohorts, though abnormalities were noted in patients with renal impairment or complex urological histories. Paternity rates varied widely (6%-58%) and were lower in individuals with renal dysfunction or urinary incontinence. Only one study used validated tools to assess quality of life, showing negative impact in domains related to continence and renal status. CONCLUSIONS: Most males treated for PUV during childhood reach adulthood with preserved sexual and reproductive potential. Given the heterogeneity and methodological limitations of the current literature, prospective studies using standardized outcome measures are needed to better define long-term risks and inform clinical follow-up.