Posterior Urethral Valves

What Causes Posterior Urethral Valves?

Posterior urethral valves most likely develop early in fetal development. They affect about 1 in 5,000 to 8,000 baby boys. Experts believe that posterior urethral valves occur by chance, although there is some evidence that a genetic component may be involved.

When posterior urethral valves obstruct the flow of urine, it causes the urine to flow backwards. When this happens, the urethra, bladder, ureters (tubes that carry urine from the kidneys to the bladder) and the kidneys may become progressively dilated or swollen. This can lead to tissue damage over time or kidney failure, which may require a transplant.

Posterior Urethral Valves Symptoms

Symptoms of posterior urethral valves can range from mild to severe and may be different in each child. The most common symptoms include:

• Enlarged bladder
• Pain with urination
• Poor weight gain
• Urinary tract infection (UTI)
• Weak urine stream

Potential complications of posterior urethral valves include long-term kidney failure. However, the risks of kidney damage and failure can be reduced when the condition is diagnosed and treated early.

Posterior Urethral Valves Diagnosis

Posterior urethral valves are often diagnosed by an ultrasound while a woman is still pregnant. It is sometimes diagnosed later if a child is having frequent UTIs. Your child may be referred to a pediatric urologist for further evaluation and treatment. To diagnose, your child’s healthcare provider will perform a physical exam and ask about your child’s symptoms and health history. Additional tests may include:

• Abdominal ultrasound: This imaging test uses sound waves to create images of internal organs.
• Blood tests: To check electrolytes and kidney function.
• Voiding cystourethrogram: Using a catheter (a thin flexible tube) inserted into the urethra, a healthcare provider fills the bladder with a liquid dye and takes X-ray images as the bladder fills and empties. The images show if there is any reverse flow of urine in the urinary tract.
• Cystoscopy: This test uses a cystoscope (a small, flexible tube with a light and a camera at the end) to look inside part of the urinary tract.

Posterior Urethral Valve Treatment

Treatment for posterior urethral valves depends on the severity of the condition, as well as your child’s symptoms, age and health. The first goal of treatment is to ease your child’s symptoms, including administering antibiotics to treat a UTI, IV fluids for possible dehydration or inserted a urethra catheter.

Many children will need surgery to treat posterior urethral valves. Surgical procedures include:

• Valve ablation: This surgery is used to remove the valves and other blockages. During the procedure, your child’s pediatric urologist will insert a cystoscope into the urethra. The cystoscope will be used to make incisions in the valve that cause them to collapse and stop obstructing the urethra.
• Vesicostomy: This procedure may be recommended for babies too small to undergo valve ablation. Your child’s provider will use the procedure to divert urine from the bladder before it gets to the urethra. He will create a small opening in the bladder through the belly so that urine can drain freely through it. The opening is fixed at a later time when the valves can be cut more safely.
• Ureterostomy / pielostomy: This procedure will create a small opening in the ureter or the kidney pelvis through the belly so that urine can drain freely through it. The opening is fixed at a later time when the valves can be cut more safely.

Follow-Up Care

After your child’s surgery, they will need to follow up with their pediatric urologist to check for any complications and to ensure that there are no blockages preventing urine flow. We recommend that your child continues to see their pediatric urologist and pediatric nephrologist throughout childhood and adolescence to monitor for any other issues that may develop with the kidneys, bladder or other parts of the urinary tract and order additional tests as needed.