Posterior Urethral Valves

Posterior urethral valves (PUV) are the most common cause of lower urinary tract obstruction in male infants. Due to improved technique and availability of prenatal imaging, diagnosis is typically suspected prenatally and confirmed postnatally. Prenatal intervention is performed in select centers with vesicoamniotic shunting or with fetal cystoscopy and antegrade ablation of the PUV when detected. Prenatal intervention has been associated with an improvement in neonatal survival; however, evidence that renal function is indeed improved remains scant. The mainstay of treatment remains early diagnosis with early establishment of drainage and subsequent management of bladder dysfunction with behavioral therapy, medication, clean intermittent catheterization, and occasionally with bladder augmentation. Other measures such as nephrectomy can be implemented to manage polyuria. Ultimately, 30 % of patients born with PUV develop end-stage renal disease and require renal transplantation.