PUV posterior urethral valve

PUV, Posterior Urethral Valve

PUV, posterior urethral valve is the most important urological condition to diagnose in the neonatal male.  This is often suspected in the antenatal ultrasound of the mother.  The typical ultrasonic findings are: bilateral hydronephrosis, hydroureter and a distended bladder.  Occasionally, the posterior urethra would also be found to be distended.

Early surgery helps to reverse some of the obstructive uropathy. The patient can be catheterised with a feeding tube and a MCU, micturition cystourethrogram Xray done to confirm the diagnosis.  The urethral catheter should be left insitu after the MCU to drain the kidneys and also to allow the urethra to dilate to facilitate subsequent endoscopic treatment.

The definitive treatment of PUV is that of endoscopic fulgration in the operating theatre.

However, if there are noun paediatric instruments and the child is well (e.g. sepsis or renal failure), an emergency treatment is that of a vesicostomy.  The vesicostomy can be closed later on when the child is better, e.g. at the age of 4 years.

PROGNOSIS:

However, the PUV has already caused obstruction inuretro and more than 50% of patients have life long bladder dysfunction and some degree of kidney failure. 

Written by:

Dr Clarence Lei Chang Moh, Consultant Urologist.

Date: 20.9.2013

Enclosures: Xray (urethrogram)  of posterior urethral valve before and after treatment.