Muljibhai Patel Urological Hospital
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Posterior urethral valves

What Is It ?

Posterior urethral valves (or PUV) are an abnormality of the urethra, which is the tube that drains urine from the bladder to the outside of the body for elimination.

Symptoms

The following are the most common symptoms of posterior urethral valves. However, each child may experience symptoms differently. Symptoms may include: an enlarged bladder that may be detectable through the abdomen as a large mass urinary tract infection, or UTI (usually uncommon in children younger than 5 years and unlikely in boys at any age, unless an obstruction is present),painful urination, weak urine stream, urinary frequency, bedwetting or wetting pants after the child has been toilet-trained, poor weight gain, difficulty with urination.

How It's Done

The abnormality occurs when the urethral valves, which are small leaflets of tissue, have a narrow, slit-like opening that partially impedes urine outflow. Reverse flow occurs and can affect all of the urinary tract organs including the urethra, bladder, ureters, and kidneys. The organs of the urinary tract become engorged with urine and swell, causing tissue and cell damage. The degree of urinary outflow obstruction will determine the severity of the urinary tract problems.

Signs and Tests

The severity of the obstruction often determines how a diagnosis is made. Often, PUV are diagnosed by fetal ultrasound while a woman is still pregnant. Children who are diagnosed later often have developed urinary tract infections that require evaluation by a physician.

This may prompt your physician to perform further diagnostic tests, which may include: abdominal ultrasound - a diagnostic imaging technique that uses high-frequency sound waves and a computer to create images of blood vessels, tissues, and organs. Ultrasounds are used to view internal organs as they function, and to assess blood flow through various vessels. Voiding cystourethrogram (VCUG) - a specific x-ray that examines the urinary tract.

Treatment

Specific treatment for PUV will be determined by your child's age, overall health, and medical history the extent of the abnormality. Treatment for PUV depends on the severity of the condition. Treatment may include the following: supportive care and endoscopic ablation.

In certain situations, a different procedure called a vesicostomy may be required. A vesicostomy is a small opening made in the bladder through the abdomen. Nearly 30 percent of boys with PUV may have some long-term kidney failure that may need to be addressed. The prognosis for PUV improves when detected early.

Causes

PUV are the most common cause of severe types of urinary tract obstruction in children. It is thought to develop in the early stages of fetal development. The abnormality affects only male infants and occurs in about one in 8,000 births. This disorder is usually sporadic (occurs by chance). However, some cases have been seen in twins and siblings, suggesting a genetic component. The syndrome may occur in varying degrees from mild to severe.