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Posterior urethral valves (PUV) are congenital obstructive leaflets of tissue in the posterior urethra that occur exclusively in males, representing the most common cause of severe obstructive uropathy in newborn boys. This condition can lead to significant complications including bladder dysfunction, vesicoureteral reflux, and chronic kidney disease if not promptly diagnosed and treated.
PUV consists of abnormal folds of tissue that act as one-way valves in the posterior urethra, allowing antegrade flow during voiding but creating obstruction that increases intravesical pressure. The elevated bladder pressures result in bladder wall thickening, trabeculation, diverticulum formation, and can cause vesicoureteral reflux, leading to hydronephrosis and potential renal dysplasia or damage.
Clinical presentation varies from severe prenatal oligohydramnios with pulmonary hypoplasia to postnatal symptoms including poor urinary stream, straining to void, urinary tract infections, and failure to thrive. Diagnosis is confirmed through voiding cystourethrography (VCUG) showing the characteristic posterior urethral dilation and valve leaflets, while renal ultrasound assesses for hydronephrosis and kidney damage that guides surgical intervention timing.