Posterior Urethral Valves in Children
What are posterior urethral valves in children?Posterior urethral valves are a problem with the urethra in a boy. The urethra is the tube that drains urine from the bladder to the outside of the body. Posterior urethral valves are small leaflets of tissue in the urethra. They have a narrow, slit-like opening. The valves partly block urine flow because not enough urine can get through them to leave the body. This causes reverse flow of urine. This can harm the urethra, bladder, ureters, and kidneys. They become too full with urine and swell. This leads to tissue damage. Posterior urethral valves are the most common cause of severe urinary tract blockage in children.
What causes posterior urethral valves in a child?Researchers believe that posterior urethral valves happen early in the growth of a baby boy in the uterus. The valves occur in about 1 in 8,000 baby boys. They are believed to happen by chance. But some cases have been seen in twins and siblings. This means a gene may be the cause.
What are the symptoms of posterior urethral valves in a child?
Symptoms can occur a bit differently in each child. They may be mild to severe. The most common symptoms include:
- An enlarged bladder that can be felt through the belly
- Pain when urinating
- Weak urine stream
- Feeling the need to urinate often
- Bedwetting or pants wetting after toilet training
- Poor weight gain
- Urinary tract infection (rare unless there is a blockage)
The symptoms of posterior urethral valves can seem like other health conditions. Make sure your child sees his healthcare provider for a diagnosis.
How are posterior urethral valves diagnosed in a child?
Posterior urethral valves are often diagnosed by fetal ultrasound while a woman is still pregnant.
A child diagnosed later often has urinary tract infections. The healthcare provider will ask about your child’s symptoms and health history. He or she will give your child a physical exam. Your child may also have tests, such as:
- Abdominal ultrasound. This imaging test uses sound waves and a computer to create images of blood vessels, tissues, and organs. The test is used to view internal organs as they work, and to look at blood flow through vessels.
- Voiding cystourethrogram (VCUG). This is a type of X-ray to look at the urinary tract. The healthcare provider puts a thin, flexible tube (catheter) in the urethra. He or she fills the bladder with a liquid dye. The provider takes X-ray images as the bladder fills and empties. The images show if there is any reverse flow of urine into the ureters and kidneys.
- Endoscopy. This test uses a small, flexible tube with a light and a camera lens at the end (endoscope). The scope is used to look inside part of the urinary tract. The healthcare provider may take tissue samples from inside the urinary tract for testing.
- Blood test. This test may be done to check your child's electrolytes and kidney function.
How are posterior urethral valves treated in a child?
Treatment will depend on your child’s symptoms, age, and general health. It will also depend on how severe the condition is. Your child may see a urologist. This is a doctor who treats the urinary tract and the male genital tract. Treatment may include:
- Supportive care. At first, treatment may focus on relieving your child's symptoms. If your child has a urinary tract infection, is dehydrated, or has electrolyte problems, these conditions will be treated first. Your child may have a catheter placed in his bladder. This is a thin, flexible tube that is put into the penis through the urethra and is gently moved up into the bladder. Your child may also be given antibiotics and IV (intravenous) fluids.
- Endoscopic ablation. This procedure is done to remove the valves and other blockages. It’s done with a small, flexible tube with a light and a camera lens at the end (endoscope).
- Vesicostomy. The healthcare provider makes a small opening in the bladder through the abdomen. The opening is repaired at a later time when the valves can be cut more safely.
Talk with your child’s healthcare providers about the risks, benefits, and possible side effects of all treatments.
What are possible complications of posterior urethral valves in a child?Nearly 1 in 3 boys with posterior urethral valves may have some long-term kidney failure that may need to be treated. The prognosis for the condition is better when it’s found early.
When should I call my child’s healthcare provider?
Call the healthcare provider if your child has:
- Symptoms that don’t get better, or get worse
- New symptoms
Key points about posterior urethral valves in children
- Posterior urethral valves are a problem with the urethra in a boy. The urethra is the tube that drains urine from the bladder to the outside of the body.
- Posterior urethral valves are small leaflets of tissue in the urethra. They partly block urine flow because not enough urine can get through them to leave the body. This causes reverse flow of urine.
- Posterior urethral valves can harm the urethra, bladder, ureters, and kidneys. They become too full with urine and swell. This leads to tissue damage.
- Posterior urethral valves likely happen early in the growth of a baby boy in the uterus.
- Posterior urethral valves are often diagnosed by fetal ultrasound while a woman is still pregnant.
- Treatment is done by removing the valves with surgery.
Tips to help you get the most from a visit to your child’s healthcare provider:
- Know the reason for the visit and what you want to happen.
- Before your visit, write down questions you want answered.
- At the visit, write down the name of a new diagnosis, and any new medicines, treatments, or tests. Also write down any new instructions your provider gives you for your child.
- Know why a new medicine or treatment is prescribed and how it will help your child. Also know what the side effects are.
- Ask if your child’s condition can be treated in other ways.
- Know why a test or procedure is recommended and what the results could mean.
- Know what to expect if your child does not take the medicine or have the test or procedure.
- If your child has a follow-up appointment, write down the date, time, and purpose for that visit.
- Know how you can contact your child’s provider after office hours. This is important if your child becomes ill and you have questions or need advice.
May 26, 2017
Management of Posterior Urethral Valves, Up To Date, Urologic Diseases in America. Pohl, H. 2007, pp. 412-15.
Adler, Liora C, MD,Brown, Kim, APRN,Freeborn, Donna, PhD, CNM, FNP