Management of posterior urethral valves

Summary 

The clinical spectrum of posterior urethral valves (PUVs) includes the stillborn fetus with Potter's syndrome, the newborn baby with significant pulmonary hypoplasia and renal failure that leads to early neonatal death, the prenatally detected or clinically presenting case that responds to early aggressive management of obstruction, infection and bladder dysfunction, and patients where the effects of obstruction are more subtle and diagnosis is delayed possibly into adult life. Although resecting the obstructing valve leaflets is relatively straightforward nowadays using state-of-the-art equipment, patients with PUVs have a constellation of associated problems that pose a continued threat to renal function through childhood. Clinicians looking after boys with PUVs need to be aware of the complex pathophysiology of the condition, the need for ongoing appropriate specialist investigation and follow-up throughout life, and the frequent occurrence of chronic renal failure despite the provision of expert multidisciplinary care.

KEYWORDS: Posterior urethral valves, Urethral obstruction, Prenatal diagnosis, Vesico-ureteric reflux, Bladder dysfunction, Renal failure, Renal transplantation