Are ‘valve bladders’ congenital or iatrogenic?

Posterior urethral valves: a single center experience over 7 years

“…Controversy continues to revolve round the use temporary high diversion for PUV. Even in the most severe cases, many pediatric urologists still do not accept the efficacy of this treatment; they believe that high diversion prevents bladder cycling resulting in non-compliant bladder and does not change the outcome of kidney function in the long run [14][15][16][17]. However, temporary high diversion may still have a role in severe cases of PUV, and may possibly improve renal function [18,19].…”

Is a vesicoamniotic shunt intrinsically bad? Shunting a normal fetal bladder

“…An important feature in the history of the valve bladder syndrome concept is a continuing debate regarding the etiology and management of the valve bladder [10][11][12], especially the debate around just what makes a valve bladder dynamically and histologically, and what causes it to develop. The debate has polarized between this being an abnormal histologic development secondary to in utero bladder outlet obstruction or an acquired lesion secondary to proximal diversion [13]. There are also ongoing concerns as to the natural history of the valve bladder and the role the valve bladder has in regard to persistent hydronephrosis and the possible risk it might pose for any transplanted kidney [1].…”

Kidney Transplantation in a Child with Posterior Urethral Valve from a Hepatitis B Virus-Carrier Mother

“…We decided that his bladder should be augmented to protect the allograft from high vesical pressure and a neourethra should be made according to the Mitrofanoff principle to be used for additional access to the bladder. Augmentation cystoplasty may be argued to be overtreatment in a boy with previous upper tract diversion, but the vast experience of the Philadelphia group [5] with children with PUV indicated that more difficulties were encountered in rehabilitating the bladder in those with previous diversion than with no diversion. In fact, detailed histochemical and scanning electron microscopic examinations of a detrusor biopsy specimen of this boy at the time of augmentation cystoplasty revealed decreased nerve density in the muscular layer and distorted three-dimensional configuration of collagen fibers, features compatible with the irreversibility of this poorly compliant bladder [6].…”