17781 Posterior Urethral Valves

Overview

Posterior urethral valves are tiny flaps of tissue that form in the tube that carries urine from the bladder out of the body (the urethra). They only affect boys. The flaps act like one-way gates, making it hard for urine to flow out. It is a problem present from birth.

It is fairly rare, affecting about 1 in 8,000 boys.

It affects baby boys. It starts while the baby is developing in the womb.

Symptoms

Common symptoms

• Slow or weak urine stream
• Straining to urinate
• Frequent urination or feeling of not emptying fully
• Urinary tract infections

Symptoms in children

• In babies: a swollen abdomen, poor feeding, failure to thrive, or a weak stream when they do pass urine.

Symptoms in older adults

• This condition is present from birth, so it does not first appear in older adulthood. If untreated, it may lead to long-term kidney or bladder problems in adulthood.

Causes

Main causes

• The exact cause is not known.
• It happens during fetal development when the urinary tract does not form correctly.

Risk factors

• Having a family history of urinary tract birth defects (though this is not always present)
• Being male (only boys have this condition)

When to see a doctor

See a doctor urgently if:

• If you notice your child has a very weak urine stream, is straining to urinate, or has a swollen belly
• If your child has a fever with flank pain

Book a routine appointment if:

• If you have concerns about your child's urination or repeated urinary tract infections
• If a pregnancy ultrasound shows signs that may point to a urinary problem

Diagnosis

Posterior urethral valves are often found during pregnancy ultrasound. After birth, doctors use a type of X-ray called a voiding cystourethrogram, or a camera test called cystoscopy to look inside the urethra.

Tests that may be done

• Prenatal ultrasound (looking at the baby in the womb)
• Voiding cystourethrogram (a special X-ray of the bladder and urethra)
• Cystoscopy (a thin tube with a camera to see the urethra)
• Blood and urine tests to check kidney function

What to expect at your appointment

If your child is diagnosed, you will meet with a specialist called a pediatric urologist. They will explain the condition and the treatment options, and answer all your questions.

Treatment

Treatment aims to remove or open the valves so urine can flow freely and protect the kidneys. The most common treatment is a minor procedure in which a doctor uses a small instrument to cut or ablate the valves.

Self-care at home

• Keep all follow-up appointments with your child's specialist.
• Watch for signs of infection, such as fever or pain when urinating.
• Encourage your child to drink enough fluids (unless the doctor says otherwise).

Medical treatments

Medical treatment usually involves surgical removal of the valves through a procedure called cystoscopy. The doctor passes a small instrument through the urethra and uses heat or laser to remove the flaps. Generally, no specific medications are needed, but antibiotics may be prescribed short-term to prevent infection.

When is surgery considered?

Surgery is the main treatment for posterior urethral valves. In some severe cases, a temporary diversion (like a tube placed in the bladder or kidney) may be needed before the main surgery.

Living with this condition

Most children return to normal activities after treatment. You may need to monitor your child's urine output and watch for signs of urinary tract infections. Long-term, some children need regular check-ups with a kidney specialist.

Lifestyle tips

• Keep up with pediatric visits
• Encourage regular physical activity
• Ensure your child drinks enough water for their age (ask your doctor for guidance)

Diet and exercise

There is no special diet for posterior urethral valves, but staying hydrated and eating a balanced diet helps keep the kidneys healthy. Your child can enjoy normal physical activities unless the doctor advises otherwise.

Mental health and emotional wellbeing

Caring for a child with a chronic condition can be stressful. It is normal to worry. Talk to your healthcare team about support services. For older children, counseling can help if they feel anxious about hospital visits or procedures.

Prevention

Posterior urethral valves cannot be prevented, as it is a birth defect that happens early in pregnancy.

Vaccines

There is no vaccine for this condition.

Screening programmes

Routine screening is not available. The condition is often detected on a routine pregnancy ultrasound.

Complications

If left untreated

• Repeated urinary tract infections
• Poor kidney function or kidney failure
• Risks of bladder and kidney damage

Long-term outlook

With early detection and treatment, the outlook is good. Many children grow up with healthy kidney and bladder function. Some may need ongoing monitoring, but with a good medical team, they can lead an active, full life.

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