Posterior Urethral Valve

Posterior Urethral Valve(PUV) is a congenital condition in which membrane in the urethra (tube that drains urine from the bladder) blocks the out flow of urine. As a result of this child is not able to empty the bladder and this leads to back pressure changes causing dilation of ureter and kidneys. If not managed in time, this can eventually cause permanent renal damage and end stage renal failure.

This incidence of this condition in male newborn is 1 in 800.

Signs and symptoms

• The diagnosis can be suspected on antenatal scan. The scan usually have findings of bilateral hydroureteronephrosis with distended and thickened bladder.
• Weak urinary stream
• Urinary track infection
• Straining while passing urine

Investigations

If clinical presentation and ultrasound are suggestive of PUV, then Voiding-cysto urethrogram (VCUG) is done to confirm the diagnosis.

This study is performed after filling the bladder with contrast under X ray fluoroscopy.

Management

The aim of treatment is:

• To relieve the obstructive membrane by valve ablation
• Preserve kidney functions by preventing UTI
• Improve the bladder function
• Valve ablation– This is performed by using a cystoscope, which is a small device passed thorough the urethra. This can even be used in newborn babies for valve ablation.
• The valves are incised under vision to relieve the obstruction.
• A temporary urinary diversion (vesicostomy and ureterostomy) is sometimes required in special situations. In urinary diversion a temporary opening is made bladder/ureter for urinary drainage.

After the above management the child will require long term follow up and medication to improve bladder and renal function. He will be monitored for his growth, urine infection, swelling in kidney etc.

He will also require consultation from paediatric nephrologist.