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Posterior urethral valves (PUV) are congenital membranous folds in the posterior urethra that obstruct urine flow, representing the most common cause of severe obstructive uropathy in male infants. This condition affects approximately 1 in 5,000 to 8,000 male births and can lead to significant kidney damage, bladder dysfunction, and long-term urological complications if not promptly diagnosed and treated.
The abnormal valve leaflets create a one-way obstruction during voiding, causing increased intravesical pressure and proximal urinary tract dilatation including vesicoureteral reflux, hydroureteronephrosis, and bladder wall thickening. Chronic high-pressure voiding leads to detrusor muscle hypertrophy, reduced bladder compliance, and progressive renal dysfunction due to back-pressure and recurrent infections.
Early recognition requires high clinical suspicion in male infants presenting with poor urinary stream, straining to void, or antenatal hydronephrosis detected on ultrasound. Voiding cystourethrography (VCUG) remains the gold standard for diagnosis, while renal function assessment and imaging help determine the extent of upper tract damage and guide treatment decisions including valve ablation timing and need for temporary urinary diversion.