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Posterior Urethral Valve Disorder (PUV)

What are posterior urethral valves (PUV)?

Posterior urethral valves are a condition in which there are extra flaps of tissue in a male’s urethra that block urine. The extra flaps of tissue are called posterior urethral valves (PUVs). They can partially or completely block the flow of urine, which causes urine to back up. The backup of urine can damage the bladder, kidneys and other parts of the urinary tract, as it causes the organs to swell. That can lead to damage of the tissues and cells within the urinary tract.

PUV disorder is a congenital defect, which means it is present at birth. It is the most common cause of severe urinary tract obstruction that affects children. It occurs in about one in 8,000 boys. Girls are not affected by PUV disorder.

Posterior urethral valve disorder varies in severity. The more severe cases can sometimes be diagnosed during a fetal ultrasound, but the less severe cases may not be diagnosed until a boy is at older.

What causes posterior urethral valve disorder?

Experts are uncertain about what causes posterior urethral valve disorder. There is some evidence that it has a genetic component, but it’s not believed to be passed from parents to children. We do know that PUV was not caused by anything you did or didn’t do before or during pregnancy.

What are the signs and symptoms of posterior urethral valve disorder?

Because PUV disorder can range from mild to severe, the symptoms will vary from child to child. Your son may not experience the same symptoms as another boy with posterior urethral valve disorder.

Some of the signs and symptoms of PUV are:

  • Severe hydronephrosis (swelling of the kidney)
  • an enlarged bladder
  • urinary tract infection (UTI)
  • pain with urination
  • frequent urination
  • a weak urine stream
  • incontinence (wetting the bed or the pants) either at night or during the day once a child has been toilet trained
  • difficulty with urination
  • difficulty gaining weight

Posterior urethral valve disorder can cause complications if it is severe. Some possible complications are:

  • bladder dysfunction
  • kidney dysfunction
  • vesicoureteral reflux (urine flowing backward from the bladder to the kidneys)
  • respiratory distress
  • kidney failure

How do you diagnose posterior urethral valve disorder?

Some cases of posterior urethral valve disorder are detected during a fetal ultrasound during pregnancy. Doctors may see hydronephrosis (dilated kidney-collecting system) or a dilated ureter during ultrasound. These signs may make a doctor suspect that PUV disorder is present. When cases are milder, they may not be diagnosed until much later – even many years after birth.

Voiding cystourethrogram (VCUG) is the standard test that helps doctors make a definitive diagnosis of PUV. VCUG is a minimally invasive test that uses X-ray technology to view the urinary tract and bladder.

The images taken during VCUG can help:

  • diagnose posterior urethral valves or vesicoureteral reflux
  • check for urethral obstructions or abnormalities
  • determine the cause of recurrent UTIs

Your child’s doctor may also perform additional tests to help with a diagnosis. Those tests include:

  • direct endoscopic visualization, also known as cystourethroscopy
  • urodynamic study (UDS)
  • blood tests

How do you treat posterior urethral valve disorder?

If your son has posterior urethral valves, treatment will depend upon a few things, including:

  • the severity of your son’s condition and the extent of the abnormality
  • your son’s age and overall health
  • your opinion and preference, along with the doctor’s

Before beginning treatment, your son’s doctor will talk with you about the options so you, along with the entire treatment team, can decide which course of action is best for your son. The treatment options may include:

  • endoscopic incision of the valves or endoscopic ablation, which trims the extra valve tissue to so the urine can flow in the manner it’s supposed to
  • treatment for any complications, such as antibiotic therapy, IV hydration and bladder catheterization
  • vesicostomy (creating an opening in the bladder through the abdomen); this is sometimes used when endoscopic ablation needs to be delayed
  • medication, such as antispasmodics, anticholinergics, to help relax the muscles in the bladder
  • urinary diversion or proximal diversion to treat hydronephrosis, which can be a complication of PUV
  • an additional voiding cystourethrogram (VCUG) to ensure the urethral valves have been corrected and urine is flowing as it should

At Beaumont, every child receives care tailored to his or her condition and symptoms. No matter what treatment(s) your son needs, we will keep you informed at all times. You are an important part of your son’s treatment team, and we value your input.