The tube draining urine from the bladder to the outside body for elimination is called urethra. A type of abnormality of the urethra is called Posterior Urethral Valve (PUV) which must be treated by urology doctors. When the urethral valves, which are small leaflets of tissue, have a narrow, slit-like opening that partially obstructs urine overflow, this abnormality occurs. Because of this, there is reverse overflow and all of the urinary tract organs including the urethra, bladder, ureters and kidneys get affected by it. There is tissue and cell damage as the organs of the urinary tract become engorged with urine and swell. The severity of the urinary tract problems is determined by the degree of urinary outflow obstruction
What causes Posterior Urethral Valves?
In the early stages of fetal development, there may be the development of Posterior Urethral Valves. Males are only affected by the abnormality and in about one in 8,000 births it occurs. The nature of this disease is normally sporadic i.e. it occurs by chance. However, in twins and siblings, some cases have been seen. This suggests a genetic component. The exact cause, in any case, can be confirmed by a urology specialist.
What are the symptoms of Posterior Urethral Valves?
There are varying degrees from mild to severe in which the syndrome may occur. The most common symptoms of Posterior Urethral Valves are given below. However, symptoms may be experienced differently by each child.
- An enlarged bladder: Through the abdomen, this may be detectable as a large mass.
Urinary tract infection: In children younger than age 5 and in boys at any age, it is usually uncommon, unless there is an obstruction
- Painful urination
Weak urine stream
- Urinary frequency
- Bedwetting or wetting pants: Even after the child has been toilet trend, this may happen.
- Poor weight gain
- Difficulty with urination
There are other conditions or medical problems that may resemble symptoms of PUV. You must also consult the best urologist for diagnosis.
How are Posterior Urethral Valves diagnosed?
The method of diagnosis is often determined by the severity of the obstruction. Often, while a woman is still pregnant, fetal ultrasound is used to diagnose PUV. In many cases, there is the development of urinary tract infections in children who are diagnosed later and this requires evaluation by a urologist doctor. Further diagnostic tests may be performed by your urologist because of this. These diagnostic tests may include:
Abdominal ultrasound : High-frequency sound waves and a computer are used in this diagnostic imaging technique for creating images of blood vessels, tissues and organs. For viewing the functioning of internal organs, ultrasounds are used. They are also used for assessing blood flow through various vessels.
Voiding cystourethrogram (VCUG) : The urinary tract is examined by this specific x-ray. In the urethra, which is the tube that drains urine from the bladder to the outside of the body, a catheter (hollow tube) is placed and with a liquid dye, the bladder is filled. As the bladder fills and empties, x-ray images will be taken.
Endoscopy : To examine the inside of part of the urinary tract, this test is done in which a small, flexible tube with a light and a camera lens at the end (endoscope) is used. For examination and testing, tissue samples from inside the urinary tract may also be taken.
Blood test : To assess your child’s electrolytes and to determine kidney function, this may be ordered.
What is the treatment of Posterior Urethral Valves?
By your urologist, specific treatment for PUV will be determined based on:
- The age, overall health and medical history for your child
- The amount of extent of the abnormality
The tolerance level of your child for specific medications, procedures, or therapies
The expected time for the course of the abnormality
Any preference or opinion of you
On the severity of the condition, the treatment of PUV depends. The following are parts of the treatment:
Supportive care: Initially, the relief of your child’s symptoms may be the focus of the treatment. At first, if there is any urinary tract infection, dehydration and/or electrolyte irregularities in your child, at first treatment will be done for these conditions. A catheter may be placed in your child’s bladder. Antibiotic therapy and intravenous (IV) fluids may also be given to your child.
Endoscopic ablation: An urologist may see your child after the initial management. A procedure called an endoscopic ablation may be performed by the urologist. The urologist will insert an endoscope, a small, flexible tube with a light and a camera lens at the end, during this procedure. He or she will examine the obstruction with this tube and remove the valve leaflets through a small incision.
Vesicostomy : A different procedure called a vesicostomy may be required in certain situations. A small opening made in the bladder through the abdomen is called vesicostomy. Usually, at a later time, this opening is repaired, when the valves can be cut more safely.
There may be some long-term kidney failure, which may need to be addressed, in nearly 30 percent of boys with PUV. If detected early, the prognosis for PUV improves.