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. 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.
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. The following are the most common symptoms of posterior urethral valves. However, each child may experience symptoms differently which includes:
The symptoms of PUV may resemble other conditions or medical problems. Always consult your child’s physician for a diagnosis.
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:
Treatment is by endoscopic valve ablation. Fetal surgery is a high risk procedure reserved for cases with severe oligohydramnios, to try to limit the associated lung underdevelopment, or pulmonary hypoplasia that is seen at birth in these patients. The risks of fetal surgery are significant and include limb entrapment, abdominal injury, and fetal or maternal death. Specific procedures for in utero intervention include infusions of amniotic fluid, serial bladder aspiration, and creating a connection between the amniotic sac and the fetal bladder, or vesicoamniotic shunt.
There are three specific endoscopic treatments of posterior urethral valves:
The standard treatment is primary (transurethral) ablation of the valves. Urinary diversion is used in selected cases, and its benefit is disputed. Following surgery, the follow-up in patients with posterior urethral valve syndrome is long term, and often requires a multidisciplinary effort between urologists, pulmonologists, neonatologists, radiologists and the family of the patient. Care must be taken to promote proper bladder compliance and renal function, as well as to monitor and treat the significant lung underdevelopment that can accompany the disorder.
Dr Mahendra Jain is an eminent and an extremely experienced Urologist ...Read More
I had undergone treatment for my prostate in Germany 5 years back. Now I developed urethral stricture, I had lot of problem passing urine.
Mr Alexis is aged 72 yrs from East Africa was treated for his long standing urinary problem with a complex surgery. Now he is back in his country