Posterior Urethral Valves: Prenatal, Neonatal, and Long-Term Management

Abstract

A posterior urethral valve (PUV) is a membranous fold within the lumen of the posterior urethra that causes functional obstruction of the urine outflow. It is a common cause of obstructive uropathy in boys during the neonatal period. The disorder varies in its severity; in extreme cases, PUVs can be incompatible with postnatal life while other patients can suffer from renal and respiratory failure associated with oligohydramnios. Milder cases can present later in life with urinary incontinence and other urinary symptoms. The management of patients with PUVs remains a clinical challenge and includes endoscopic surgical resection of the urethral valve and follow-up during early infancy and adulthood to avoid progressive bladder dysfunction and monitor for chronic renal disease. This review will address the management of PUVs during the prenatal period, the neonatal period, and throughout the entire life of the patient.

Persistent diurnal enuresis in a 6-year-old boy after bilateral ureteroneocystostomy

“…Surprisingly our patient had only diurnal enuresis and abdominal pain possibly caused by hydronephrosis. Although voiding cystourethrography is considered to be a golden standard [5] of PUV detection, only urethrocystoscopy can confirm valves, identify their type, and enables causative treatment (ablation/ incision of PUV) [6]. Unfortunately in the presented case in the first cystourethrography urethra was not visualized which was misleading.…”

Late diagnosis of posterior urethral valves: a case report and the literature review

“…PUV are usually suspected on the routine prenatal US showing dilation of the posterior urethra, thickening of the urinary bladder wall ("keyhole" sign), and upper urinary tract dilation (megaureters and hydronephrosis). Every male child with such findings should be considered to have PUV until proven otherwise [8]. In cases of PUV with manifestation in infancy and early childhood, the symptoms may vary depending on the severity of the obstruction they cause.…”

“…Patients often have UTIs, poor urine stream, voiding problems, or even acute kidney injury [9]. The only causative treatment is urethrocystoscopy which confirms the presence of the urethral valves, identifies their type, and enables ablation [8].…”

Choosing the Right Catheter for Pediatric Procedures: Patient Considerations and Preference

“…A detailed discussion of such treatment is beyond the scope of this text, but antenatal treatment is reserved for only the most severe cases and consists of percutaneous vesicoamniotic shunt placement. 36 This intervention is only offered at the most specialized of institutions that are able to offer jointly the obstetric, pediatric urologic, and potential pediatric care necessary to best maximize success.…”