Posterior Urethral Valves

Introduction

Posterior Urethral Valves is a congenital mucosal folds situated in the prostatic/ membranous urethra, causing
urine outflow obstruction.
It occurs in males.
It is the most common
mechanical cause of renal deterioration in children.

Clinical features

Obstructive urinary symptoms

  • Urinary retention
  • Failure to thrive
  • Distended bladder with palpable kidneys

Differential diagnoses

  • Anterior urethral valves
  • Congenital bladder neck hypertrophy
  • Congenital urethral stricture
  • Meatal stenosis
  • Posterior urethral polyp

Complications

  • Recurrent urinary tract infections
  • Septicaemia
  • Bladder dysfunction
  • Bladder stones
  • Hydroureter/hydronephrosis
  • Progressive renal impairment
  • Failure to thrive

Investigations

  • Urinalysis
  • Urine microscopy, culture and sensitivity
  • Full Blood Count
  • Serum Urea, Electrolytes and Creatinine
  • Abdominal ultrasound
  • Micturating cysto-urethrogram
  • Urethrocystoscopy

Treatment

Treatment objectives

  • To relieve obstruction
  • Treat any complications

Non-drug treatment

  • Valve resection with endoscopes
  • Valve avulsion with valvotomes

Drug treatment

  • None
  • Supportive measures
  • Correct dehydration and electrolyte
    imbalance
  • Treat infection with appropriate antibiotics
  • Urinary diversion: vesicostomy

Prevention

  • Not applicable