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Pediatric – Posterior urethral valve

Normal functioning of urinary system

The urinary system is made of the kidneys, the bladder and the ureters mainly. The kidney is supposed to filter the blood and remove toxins and waste from it to form urine. The kidneys expel the urine through the ureters into the bladder where it is stored. Once the bladder gets sufficiently full it expels the urine through the urethral opening, out of the body.


What are posterior urethral valves?

Posterior urethral valves, or PUV for short, results from abnormal development of the urethral valves. In this condition, the small tissue leaflets which regulate the one-way flow of urine from the bladder into the urethra develop a narrow, slit. This hinders the normal flow of urine and causes the urine to flow back into the bladder. It can affect the various parts of urinary tract, such as kidneys, ureters, bladder and urethra. It results in swelling of these organs with accumulation of urine and cause damage to tissue and cells of the organs. The severity of urinary tract problems is determined by the amount of obstruction for normal flow of urine out of the body.


What is the cause of posterior urethral valves?

PUV is the most common type of a severe urinary tract blockage condition, seen mostly in children. It is believed to develop in the early fetal developmental stage. This affects mostly male babies and 1 out of every 8,000 children is affected by this condition at birth.

This is a rare disorder however research has shown a vulnerability of siblings and twins contracting this disorder where genetic mutation is suspected to be the cause.


What are the symptoms of posterior urethral valves?

The symptoms help to determine whether the condition is mild or severe. These are the commonly seen symptoms of posterior urethral valves:

  • Abnormally large bladder which is felt through the abdomen

  • UTI (urinary tract infection)

  • Pain while urinating

  • Weak stream while urinating

  • Inability to control urine frequency and occurrence

  • Urinary frequency

  • Slower weight gain

  • Problems with urination

The symptoms may vary in degree in different individuals and their exact diagnosis is essential to determine the best-suited treatment for them.


How are posterior urethral valves diagnosed?

The type of diagnosis test is mainly determined by the degree of obstruction of the urine. During pregnancy, ultrasound test is normally performed to check for obstructions in the urinary system of the fetus. After birth, UTI is often the reason for successful diagnosis of this condition.


Additional diagnostic tests include:

  • Abdominal ultrasound – This requires using powerful sound waves to create an image of the blood vessels, organs and tissues as well. This helps to view the workings of the internal organs without the need to perform invasive surgical techniques.

  • VCUG (voiding cystourethrogram) – This is a precise x-ray test that examines the urinary tract specifically. A catheter (small hollow surgical tube) is inserted gently through the urethra into the bladder which is then filled with contrast dye. Then x-ray images are taken to check the functioning of the bladder and the normal flow of urine.

  • Endoscopy – This is a minimally invasive procedure. It requires inserting a small and flexible surgical tube near the urinary tract. There is a small cold light source and miniature camera attached to the end. This helps the doctor to examine the tissues removed using an endoscope as well.

  • Blood tests – These are useful to determine the kidney function and level of electrolytes in the child.


How are posterior urethral valves treated?

The child’s physician will consider several factors before determining the best-suited treatment method. The physician will consider these factors related to your child:

  • Age

  • Extent of abnormality

  • Allergies (if any)

  • Your opinion and preference

The severity of the condition mainly helps to decide the treatment method in individual cases.

Treatment of posterior urethral valves (PUV) may include:


Supportive care

Initially, this treatment aims to treat the visible symptoms being seen in the child. In case of UTI, dehydration and inefficient level of electrolytes in the body, these symptoms are treated first.

A catheter placed in the bladder will help the child urinate easier. Antibiotics are also administered to prevent further infections.


Endoscopic ablation

After this, the urologist may choose to perform an endoscopic ablation. This is a minimally invasive surgical procedure involving the use of a small and flexible surgical tube (endoscope) to remove the blockage using miniature surgical cutting tools.


Vesicotomy

In certain cases, a Vesicotomy is necessary for effectively treating symptoms related to posterior urethral valves condition. This requires making a small incision in the bladder through the abdomen. This allows the surgeon to remove and replace the blocked and malfunctioning valves effectively.

Studies show that almost 30% of boys affected by PUV may show kidney failure in the future if the condition is not addressed effectively. Posterior urethral valves (PUV) treatment in India is advanced, effective and safe.


What are the complications that are seen?

These are the rare complications that may be seen after treatment of PUV:

  • Urinary incontinence

  • UTI

  • Kidney failure

  • VUR


What is the prognosis after treatment for posterior urethral valves (PUV)?

The extent of the damage determines the success of treatment for PUV. Once the urologist has all the test results and reports, they will be able to advise you best. Follow-up appointments may be scheduled to check the progress of healing and success of the treatment.

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