UROLOGY · CONDITIONS
Posterior Urethral Valve
Congenital obstructing membrane in the male urethra — the most common cause of severe obstructive uropathy in male neonates. Early diagnosis and valve ablation are critical.
ABOUT THIS CONDITION
What is Posterior Urethral Valve?
Posterior urethral valves (PUV) are abnormal obstructing membranes within the posterior male urethra present from birth. They cause bilateral hydronephrosis, bladder dysfunction, and progressive renal impairment — the most common cause of end-stage renal disease in male children. Many cases are now detected antenatally by foetal ultrasound showing bilateral hydronephrosis. Dr. Vipin provides emergency neonatal urethral catheterisation, endoscopic valve ablation once the urethra is of suitable calibre, and long-term surveillance of renal function and bladder dynamics in all PUV patients.
SIGNS TO WATCH
Common Symptoms
Symptoms that need attention
WHY IT HAPPENS
Causes & Risk Factors
- Congenital development of obstructing valve leaflets during embryogenesis
- Type I PUV — most common (95%) — fused valve leaflets at verumontanum
- Male sex — exclusively affects males
- Severity varies — mild obstruction may present late in childhood
- No identifiable genetic or environmental cause confirmed
- Degree of in-utero obstruction determines severity of renal damage
CLINICAL DETAILS
KeyFacts
Most cases now detected antenatally — allows immediate post-natal catheterisation and planning.
Urethral catheter placed immediately after birth to drain the bladder and protect the kidneys.
Voiding cystourethrogram confirms valve type and degree of vesicoureteral reflux.
Endoscopic fulguration of the valve leaflets — once urethra is ≥8–10 Fr calibre in the neonate.
PUV bladder (high-pressure, poor compliance) requires long-term urodynamic monitoring.
Nadir creatinine at age 1 year is the best predictor of long-term renal function.
HOW WE TREAT IT
Treatment Approach
Transurethral Valve Ablation (Endoscopic Fulguration)
A paediatric cystoscope is passed through the urethra and the obstructing valve leaflets are fulgurated or incised under direct vision — restoring normal urethral drainage without incision.
- 1
Emergency Catheterisation
Urethral catheter placed immediately after birth to drain the obstructed bladder and prevent further upper tract damage while ablation is planned.
- 2
VCUG & Imaging
Voiding cystourethrogram grades the valve and identifies associated VUR. DMSA scan and renal function tests assess bilateral kidney damage.
- 3
Valve Ablation
Once the urethra is of adequate calibre, endoscopic fulguration of the valve under direct vision is performed — typically at 6–8 weeks of age.
- 4
Long-term Follow-up
Annual renal function, bladder urodynamics, and DMSA scanning monitor for progressive renal impairment and bladder dysfunction throughout childhood.
AVAILABLE TREATMENTS
Treatment Options
Transurethral Valve Ablation
Endoscopic fulguration or incision of the valve leaflets under direct vision — the definitive primary treatment for PUV.
Vesicostomy (Blocksom's)
Temporary cutaneous bladder stoma for continuous urine drainage in neonates too small for urethral instrumentation or with severe bladder dysfunction.
Ureterostomy / Upper Tract Diversion
Cutaneous ureterostomies for neonates with severe upper tract dilatation not responding to vesicostomy alone — to maximise renal salvage.
COMMON QUESTIONS
Frequently Asked
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