From the Guidelines
Posterior Urethral Valves (PUV) typically present with bladder outlet obstruction, which can lead to urinary tract abnormalities such as hydronephrosis, vesicoureteral reflux (VUR), and bladder wall thickening.
Clinical Presentations
- Bladder wall thickening
- Dilated posterior urethra
- Hydronephrosis
- Vesicoureteral reflux (VUR)
Diagnostic Considerations
The diagnosis of PUV is often suspected in male infants with moderate or severe hydronephrosis found on neonatal ultrasound (US) 1.
Key Findings
Fluoroscopic Voiding Cystourethrography (VCUG) can be used to identify the presence of VUR and evaluate for bladder outlet obstruction from PUV 1. In cases of suspected PUV, catheterization of the bladder at birth to decompress the urinary tract and beginning prophylactic antibiotics should be considered 1. PUV is a common cause of neonatal bladder outlet obstruction, occurring in up to 6% of cases with severe antenatal hydronephrosis 1.
From the Research
Clinical Presentations of Posterior Urethral Valves (PUV)
The clinical presentations of PUV can vary, but common symptoms include:
- Diurnal enuresis, which was present in 60% of cases 2
- Urinary tract infection, which was present in 40% of cases 2 and 40.8% of cases 3
- Voiding pain, which was present in 13% of cases 2
- Poor stream, which was present in 51% of cases 3
- Gross hematuria and proteinuria, which were present in less than 10% of cases 2
- Recurrent urinary tract infection, which was the most common postnatal presentation in 21.9% of cases 4
- Incontinence, which was present in 4.7% of cases 4
Radiographic Findings
Radiographic findings associated with PUV include:
- Hydronephrosis, which was present in 40% of cases 2 and 82.6% of cases 3
- Vesicoureteral reflux, which was present in 33% of cases 2 and 61.2% of cases 3
- Renal dysplasia, which was significantly more likely in antenatally diagnosed cases 5
Renal Function
Renal function can be impaired in patients with PUV, with: