Posterior Urethral Valves

Overview

What are posterior urethral valves?

Posterior urethral valves, also called PUVs, is a rare birth defect in boys. Boys with posterior urethral valves have an abnormal fold of tissue in the urethra that blocks urine from flowing out of the bladder. The urethra is the tube that drains urine from the bladder and carries it out of the body.

In boys with this condition, the urethral valves have a very narrow opening that prevents urine from flowing out of the body. Urine can then flow back into the body and damage the organs of the urinary tract, including the urethra, bladder, ureters (the ducts by which urine passes from the kidney to the bladder and kidneys).

What are the dangers of posterior urethral valves?

If posterior urethral valves are not diagnosed early, severe damage can be caused to a child’s urethra, bladder, ureter and kidneys. The organs of the urinary tract can swell with urine and tissue damage can result.

Symptoms and Causes

What causes posterior urethral valves?

Posterior urethral valves is a rare condition affecting males. The cause is not known. It occurs in the early stages of fetal development. About 1 in 8,000 to 10,000 male infants are affected.

What are the symptoms of posterior urethral valves?

Symptoms of posterior urethral valves can range from moderate to severe. The most common symptom is a urinary tract infection.

Symptoms can include:

If your infant has any of these symptoms, you should seek medical attention as soon as possible. If left untreated, PUVs can lead to severe urinary tract problems.

Diagnosis and Tests

How are posterior urethral valves diagnosed?

Sometimes, posterior urethral valves are diagnosed via an ultrasound before a baby is born.

After birth, the condition is also usually diagnosed through an ultrasound. If your infant’s doctor suspects he may have PUVs, a series of tests will likely be performed to test for the condition. They include:

  • Abdominal ultrasound: An ultrasound of the kidneys and urinary tract can detect a mass or obstruction
  • Voiding cystourethrogram: An X-ray of the urinary tract enables your doctor to see a direct image of the bladder and ureters
  • Cystoscopy: This test that uses a small, flexible tube with a light and a camera lens at the end to look inside the urinary tract
  • Blood test: A blood test can help determine your child’s kidney function

If your child’s doctor determines that he has posterior urethral valves, he or she will come up with a treatment plan to best address the severity of your child’s condition.

Management and Treatment

How are posterior urethral valves treated?

Treatment for posterior urethral valves depends on the severity of your child’s condition. The amount of damage that can occur to a child’s urinary tract depends on how badly the urethra is obstructed and how long it takes to diagnose the condition. In some boys with severe PUV, the urine will reflux—which is backing up of bladder urine into the kidneys—causing gradual damage to the kidneys and leading to kidney failure.

The most common treatment for posterior urethral valves is a minor surgical procedure to remove the obstructing valve. This is done through a cystoscope with a camera that is inserted into the urethra. The valve is burned away (ablated).

Boys with a more severe case of PUV may also need to temporarily use a catheter to empty the bladder. A vesicostomy, a small opening in the bladder made through the abdomen, may also be made to help with urinary flow.

Medication may also be prescribed to treat urinary tract infections or for relaxing the bladder muscle.

Prevention

Can posterior urethral valves be prevented?

Posterior urethral valves develop before a child is born and cannot be prevented. This condition can sometimes be seen prenatally (before birth) and it is usually treated after the child is born.

Outlook / Prognosis

What is the prognosis for posterior urethral valves?

Most boys with posterior urethral valves will be able to lead a normal life. They will likely need to have periodic blood tests done to monitor their kidney function until adulthood.

Last reviewed by a Cleveland Clinic medical professional on 07/14/2018.

References

  • Talabi A, Sowande O. . Nigerian Journal of Surgery. 2015 Jul-Dec;21(2):151-156. Accessed 7/16/2018.Posterior Urethral Valves in Children: Pattern of Presentation and Outcome of Initial Treatment in Ile-Ife, Nigeria (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4566324/)
  • Bhadoo D, Bajpai M. . Journal of Indian Association of Pediatric Surgeons. 2014 Jul-Sep;19(3):133-137. Accessed 7/16/2018.Posterior urethral valve: Prognostic factors and renal outcome (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4155628/)
  • University of California, San Francisco. Department of Urology. . Accessed 7/16/2018.Posterior Urethral Valves (https://urology.ucsf.edu/patient-care/children/urinary-tract-obstruction/posterior-urethral-valves)
  • Up To Date. . Accessed 7/16/2018.Management of posterior urethral valves (https://www.uptodate.com/contents/management-of-posterior-urethral-valves)

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