Posterior Urethral Valve: Diagnosis, Symptoms and Surgery Types

Posterior urethral valve or PUV is a rare congenital condition that affects a child from birth. Though the primary cause of this condition is still not known, it is curable with proper treatment. Also, PUV is a rare congenital anomaly that only affects babies who are assigned male at birth. In this condition, the child is born with a flap (extra) of tissue in his urethral valve or tube. This obstructs the urinary tract and prevents urine from passing through the bladder and out of the body.

This condition leads to trapping urine or pee inside the body. As a result, the traps damage urinary organ cells and swollen urinary tract and bladder. However, timely surgical intervention can help prevent fatal circumstances. It would let the affected live a normal life again. Today, we will discuss everything about PUV, including its causes, symptoms, diagnosis, and treatment.

What is the posterior urethral valve?

Before discussing PUV causes, symptoms, or treatments, let's begin with the basics. Let's talk about what is post urethral valve. It will help you understand the condition better. PUV is a rare congenital disability that only occurs in babies assigned to males at birth. PUV or posterior urethral valves are obstructive membranes (a fold of tissue) that develop in the urethral. Urethral is a tube or valve that passes urine from the bladder and out of the body. The valve can block or obstruct urine's outflow.

Due to this obstruction, urine traps inside the body. This leads all related organs, such as the kidney, ureters, and bladder dilated/damaged.

How posterior urethral valve is diagnosed?

Diagnosing the PUV requires a series of tests to determine whether it is PUV or something else. Your child's physician may begin with identifying the posterior urethral valve types. It is what your child has. Understanding its current condition helps to find a suitable treatment plan. Here are some common tests used for diagnosis of posterior urethral valves in children and newborns-

1. Voiding Cystourethrogram

In this test, a catheter is inserted in the bladder. It is to fill it with a fluid named contrast. And when the liquid is filled an X-ray machine takes pictures of the bladder. Later, the physician examined the pictures to find the obstruction in the urinary tract.

2. Renal ultrasound

Rental ultrasound is helpful to identify any blockage in the kidney and urinary tract.

3. Cystoscopy

Another popular method of posterior urethral valve diagnosis. Here a flexible rubber tube with a micro camera lens and flashlight is inserted in the urethral. The flashlight is at the end of the tube. This is inserted to take pictures of the urinary tract.

4. Blood test

Doctors can also suggest blood tests along with other tests to check the condition of the child's kidney.

Causes of posterior urethral valve

Posterior urethral valve is a rare disorder that does not affect many children. This disorder usually occurs during the early stages of pregnancy. At this stage, various organs of the fetus begin to form. The causes of this congenital disorder are still unknown. Some doctors suggest that this disorder can be genetically passed from one generation to another. In such cases, the father and the son suffer from this disorder. However, the majority of medical doctors and researchers rule out the assumption. They don't believe that PUV is genealogical. A baby does not inherit this disorder from their mother or father. It is also not caused by what the mother eats or does during the pregnancy.

Symptoms of posterior urethral valve

The posterior urethral valve symptoms do not surface immediately in mild cases. In mild cases of PUV, the symptoms begin to appear near or after the age of 10 years. It is when severe dilation of the kidney or hydronephrosis has occurred. Also, with time, the symptoms get worse and even lead to kidney failure or bladder infection. Also, remember that the symptoms of mild PUV can vary from one child to another. It depends on their body and condition.

For instance, some kids may face painful urination or an enlarged bladder in the posterior urethral valve. In others, these symptoms may be absent.

Here are some common posterior urethral valve symptoms -

• Painful urination
• Enlarged bladder that can be observed from the outside of the abdomen (appearing as a bundle of mass).
• Urinary tract infection.
• Urinary frequency.
• Weak urine stream.
• Difficulty in urination.
• Wetting the pants or bed wetting even after the child is toilet trained.
• Poor weight gain.

On the other hand, symptoms of PUV change in severe cases that often appear as a medical complication. Here are some common symptoms of severe PUV-

• Dilation of kidney or hydronephrosis.
• Respiratory distress.
• Renal function impairment.
• Increased chances of kidney failure.
• Vesicoureteral reflux is a condition where urine flows back from the bladder to the kidney.

Surgical intervention for posterior urethral valve (Valve Ablation, Vesicostomy)

Posterior urethral valve surgery and treatment depends on several factors. Some of the factors are -

• The age of your child,
• Condition of the bladder and kidney,
• Severity of PUV or posterior urethral valve, etc.

Depending on these factors, your child's healthcare provider creates a suitable treatment plan for your child. Here are some common surgical interventions used to treat posterior urethral valve-

1. Valve Ablation

Posterior urethral valves need to be removed once identified. It is done to restore the bladder and kidney function. In valve ablation, the urologist will insert a cystoscope and a microincision tool. A cystoscope is a flexible tube that has a tiny camera lens and light attached at the end. Then, the doctor uses the cystoscope to look inside. The doctor uses the incision tool to make an incision in the valve. Then it is left to fall off.

2. Vesicostomy

Your child's urologist may suggest a vesicostomy if your child is a newborn. It is also recommended if a condition is complicated. This condition might require a significant amount of incision. In vesicostomy, an opening in the bladder is added to ensure smooth urine drainage. Here, the urologist made a slit on the bladder wall. Then, they turn the bladder wall inside out and stitch it to the upper abdomen. Remember this procedure is a temporary solution only. In the future, the slit can be sewn together after successful valve ablation.

3.  Ureterostomy

This procedure is less common. It is usually not suggested by doctors because of related complications. Ureterostomy involves disconnecting the ureter from the bladder. Then it is reconnected with the organ to an opening in the belly. This procedure aims to lower the chances of urinary tract infection by taking the pressure of the kidneys.

Preparation for the surgery

The doctor may suggest surgery if your child has been diagnosed with a posterior urethral valve.  Then you should prepare your baby and yourself for the upcoming surgery. Prepare yourself mentally, physically, and emotionally to support your child. Talk to the doctor about the procedure.  How long it will take, how you should prepare your baby, and what to expect after the surgery. It will help you have a clear idea and prepare for the surgery.

Best Urology Surgeons for Posterior Urethral Valve Surgery

1. Dr. Gautam Banga

Dr. Gautam Banga is a pioneer urology surgeon in India. He has vast experience in treating various urology-related issues like phimosis, and Peyronie’s disease, etc. He is an expert in frenuloplasty and other cosmetic urology.

2. Dr. Vijayant Govinda Gupta

Dr. Vijayant Govinda Gupta is widely known as a penile implant surgeon. He has proficiency in urology surgeries. Dr. Viajayant Gupta does surgeries like orchiopexy, frenuloplasty, phimosis(child & adult), paraphimosis, circumcisions, etc.

3. Dr. Raman Tanwar

Dr. Raman Tanwar is one of the top urological surgeons in India. He has expertise in surgeries like vasectomy, phimosis, epispadias, and minimally invasive surgery like LASER circumcision.

4. Dr. Vineet Malhotra

Dr. Vineet Malhotra is the best urology doctor. He performs various endourology, reconstructive, and laparoscopic procedures. With his extraordinary talent, Dr. Vineet Malhotra is now a member of many renowned institutions globally.

Posterior urethral valve: Recovery

Babies with low PUV can receive treatment after posterior urethral valve diagnosis. They will recover with time. They might not need lifelong follow-ups. Babies with moderate to severe PUV might need lifelong follow-ups after their primary treatment is done. Some children can also need lifelong care. Boys with PUV can also develop CKD (chronic kidney disease) during the later stages of their lives. This can also result in kidney failure. Expert multidisciplinary care can help boys with PUV lead normal lives. This ensures proper development of the bladder and kidney.

Posterior urethral valve surgery in newborn

Doctors usually suggest PUV surgery for newborns. Instead, other measures are taken into account to deal with this health crisis. A doctor primarily aims to drain out the urine from a newborn's bladder to offload the kidneys. A tube or catheter is used for this purpose. A PUV surgery is only performed when a newborn grows up a bit. A pediatric urologist performs PUV resection by using cystoscopy. The procedure requires a pediatric urologist to place a cystoscope through the urethra. The cystoscope helps them see inside the urethra and surgically remove the valves.  In some rare cases, experts may suggest posterior urethral valve surgery for newborns. This is due to potentially life-threatening complications.

Posterior urethral valve surgery FAQs