Posterior urethral valves

  • Posterior urethral valves
  • These folds of urothelium cause obstruction to the urethra of boys.
  • They are usually just distal to the verumontanum  (MCQ)
  • They are flap valves and so, although urine does not flow normally, a urethral catheter can be passed without difficulty. (MCQ)
  • Dilatation of the urinary tract now commonly leads to diagnosis by ultrasound scanning before birth. (MCQ)
  • Other cases present with urinary infection in the neonatal period.
  • Sometimes the valves are incomplete and the patient is symptom free until adolescence or adulthood.
  • Posterior urethral valves need to be detected and treated as early as possible to avoid the development of renal failure. (MCQ)
  • The valves can be difficult to see on urethroscopy because the flow of irrigant sweeps them into the open position. (MCQ)
  • If the bladder is filled with contrast medium, the dilatation of the urethra above the valves can be demonstrated on a voiding cystogram(MCQ)
  • The bladder is hypertrophied and often shows diverticula.
  • Typically, there is vesicoureteric reflux into dilated upper tracts
  • Treatment
  • A suprapubic catheter is inserted to relieve the back pressure and allow the effects of renal failure to subside before definitive treat- ment by transurethral resection of the valves. (MCQ)

osterior Urethral Valve (PUV) Fulguration by Dr.Robbani
Posterior Urethral Valve is a congenital cause of bladder outflow obstruction. It may lead to Ch.retention of urine, Bil.HDUN and ultimately to renal failure if remain untreated. PUV can easily be destroyed by endoscopic fulguration.
36-Posterior urethral valve (PUV).flv
Posterior Urethral Valves – Obstructive Nephropathy
Posterior urethral valves (PUV) are small congenital membranes of abnormal tissue that occur in the urethra of newborn boys. These occur in 1 to 8,000-25,000 births. These can cause severe blockage of the entire urinary tract, including the bladder, ureters, and kidneys. The kidneys produce amniotic fluid, the fluid surrounding a baby in the womb. PUV can cause a decreased amount of this fluid to be produced leading to poorly formed lungs and breathing problems, which are the most common cause of early death in PUV patients. Bladder problems associated with PUV can persist into adulthood, and approximately 15% of valve patients will progress to renal failure resulting in the need for dialysis and/or a kidney transplant. Treatment is directed at correcting chemical abnormalities due to poor kidney function and surgery is necessary early in life to remove the valves and restore normal urine flow.
7.4.2. Posterior Urethral Valves – KUB X-rays – Dr. Vaidya
Azayem Procedures – Trans Uurethral Resection (T.U.R) Of Congenital Urethral Valves- 3 cases.
Bilateral Hydronephrosis with Posterior Urethral Valve.MPEG.3gp
Posterior urethral valves This urethral abnormality occurring in boys. There is a thick membrane in the posterior urethra which behaves as a valve so that, the infant is unable to adequately void and empty the bladder. This causes a typical dilation of the posterior urethra, proximal to the obstructing valve. On sonography there is distended thick wall urinary bladder, dilated & tortuous distal ureter & bilateral hydronephrosis with key hole appearance seen in the region of posterior urethra..
Posterior Urethral Valves: Prenatal and Postnatal Evaluation and Management
Posterior urethral valves are the most common cause of urethral obstruction in a male child. It has significant effects on the development of upper urinary tracts and in the evolution of urinary bladder function. The effect on the kidneys and the urinary bladder persists even after the successful management of the obstructing valves which is why a multidisciplinary approach is so important to the child’s long term outcome.
Posterior urethral valves
Fetal ultrasound showing a male fetus with posterior urethral valves
Cystoscopic Posterior urethral valve fulguration.
10 day old baby had a curtain like structure blocking the flow of urine. This valve was destroyed relieving the urinary tract outflow obstruction.