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Posterior Urethral Valves and Ureterovesical Junction Obstruction

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Pediatric Urology

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Abstract

Primary aims in the diagnosis and management of posterior urethral valves (PUV):

  1. 1.

    To prevent acquired renal damage.

  2. 2.

    To improve bladder function.

A secondary aim is to facilitate achievement of urinary continence.

Summary of evidence for these goals:

Case series report end-stage renal disease (ESRD) in from 3 to 42 % of patients during mean follow-up ranging from 4 to 12 years:

  • No prenatal finding (oligohydramnios, anamnios, renal hyperechogenicity, loss of corticomedullary differentiation) or fetal urine test accurately predicts postnatal renal function.

  • Prenatal bladder drainage improves survival but not renal function.

  • Neither prenatal versus postnatal diagnosis, nor age at postnatal diagnosis, predicts likelihood for ESRD.

  • There are conflicting results from retrospective analyses regarding potential risk for CRF/ESRD by vesicoureteral reflux (VUR), recurrent febrile UTI (fUTI), bladder dysfunction, and/or pop-off mechanisms.

Factors predicting poor renal functional outcomes are nadir creatinine >1 mg/dL and abnormal initial postnatal renal ultrasound with hyperechogenicity, volume loss, and/or loss of corticomedullary differentiation.

There are no reports of longitudinal objective analysis of bladder function after valve ablation:

  • One study compared UD in infants after ablation to control males with UTI, reporting no difference in median maximum voiding pressures.

  • Three retrospective studies found increased bladder capacity and decreased end filling pressures in bladders after valve ablation versus urinary diversion, but did not account for selection bias.

  • Continence is reported by age 5 in approximately 20–60 %.

  • There are few data regarding indications and outcomes for medical bladder therapy in valve patients using anticholinergics, alpha-blockers, and/or CIC.

One matched cohort study using validated questionnaires reported adult men mean age 37 years with prior valves had 2× greater LUTS than controls.

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Authors and Affiliations

  1. Department of Pediatric Urology, University of Texas Southwestern Medical Center and Children’s Medical Center Dallas, 1935 Medical District Drive, MS F4.04, Dallas, TX, 75235, USA

    Warren T. Snodgrass M.D.

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  1. Warren T. Snodgrass M.D.
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Correspondence to Warren T. Snodgrass M.D. .

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Editors and Affiliations

  1. Children’s Medical Center Dallas, Department of Pediatric Urology, University of Texas Southwestern Medical, N/A, Dallas, 75235, Texas, USA

    Warren T. Snodgrass

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Snodgrass, W.T. (2013). Posterior Urethral Valves and Ureterovesical Junction Obstruction. In: Snodgrass, W. (eds) Pediatric Urology. Springer, New York, NY. https://doi.org/10.1007/978-1-4614-6910-0_15

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  • DOI: https://doi.org/10.1007/978-1-4614-6910-0_15

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  • Publisher Name: Springer, New York, NY

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