Posterior Urethral Valve: Symptoms, Causes, Treatment, and More

A urinary tract with a posterior urethral valve

When it comes to urological conditions, Posterior Urethral Valve Syndrome (PUVS) is one that requires immediate and appropriate medical attention. It occurs more commonly in boys than girls, about one in every 8,000 male births. In this article, we will explore the causes, symptoms, diagnosis, and management of PUVS in detail. So, let’s dive in!

Understanding the Urinary Tract System

To understand PUVS, it’s important to first have a basic understanding of the urinary tract system. The urinary tract system consists of the kidneys, ureters, bladder, and urethra, which work together to produce and expel urine from the body. The urethra is the tube that carries urine out of the bladder and through the penis.

The kidneys are responsible for filtering waste and excess fluids from the blood, which are then turned into urine. The urine travels down the ureters, which are tubes that connect the kidneys to the bladder. The bladder is a muscular sac that stores urine until it is ready to be expelled from the body. When the bladder is full, the muscles in the bladder wall contract, forcing urine out of the body through the urethra.

It’s important to keep the urinary tract system healthy by drinking plenty of water, practicing good hygiene, and seeking medical attention if any symptoms of infection or other issues arise. PUVS, or posterior urethral valves, is a condition that affects the urethra in male infants and can cause urinary tract problems. It’s important for parents to be aware of the signs and symptoms of PUVS and to seek medical attention if they suspect their child may be affected.

What are Posterior Urethral Valves?

Posterior urethral valves refer to a condition where there are extra flaps of tissue within the urethra near the opening of the bladder. These flaps, or valves, can obstruct the flow of urine from the bladder and cause a backflow of urine. This can lead to a wide range of complications such as urinary tract infections, bladder and kidney damage, and in severe cases, kidney failure.

Posterior urethral valves are a rare condition that primarily affects male infants. It is estimated that this condition occurs in approximately 1 in every 8,000 male births. The exact cause of posterior urethral valves is unknown, but it is believed to be a result of abnormal development during fetal growth. Early diagnosis and treatment are crucial in managing this condition and preventing long-term complications.

Types of Posterior Urethral Valves

PUVS is classified into three types, depending on the severity of the condition. These types include:

  1. Membranous posterior urethral valves: where there are thin membranes covering the urethra opening that can obstruct the flow of urine.
  2. Leaf-like posterior urethral valves: where there are anomalous growths of bladder tissue that obstruct the opening of the urethra.
  3. Congenital anterior urethral diverticulum: where there is a sac-like protrusion in the front of the urethra that can obstruct urine flow.

PUVS is a rare congenital condition that affects male infants. It occurs when there is an abnormality in the development of the urethra during fetal growth. The condition is usually diagnosed during prenatal ultrasounds or shortly after birth when the baby experiences difficulty urinating.

The severity of PUVS can vary from mild to severe, and it can lead to complications such as urinary tract infections, kidney damage, and even kidney failure. Treatment for PUVS typically involves surgery to remove the obstructing tissue or to widen the urethra opening to allow for better urine flow.

How Common is Posterior Urethral Valve Syndrome?

PUVS is considered a rare condition, with about 1 in every 8,000 male infants being diagnosed with it. This condition is more common in boys than girls, and it’s believed that genetics may play a role in its development.

While PUVS is rare, it can have serious consequences if left untreated. It can lead to urinary tract infections, kidney damage, and even kidney failure. Early diagnosis and treatment are crucial for managing this condition and preventing long-term complications.

Symptoms of Posterior Urethral Valve Syndrome

The symptoms of PUVS can vary from mild to severe, and they may include:

  • Frequent urination
  • Difficulty urinating, including straining, dribbling, or weak urine flow
  • Bedwetting
  • Recurrent urinary tract infections
  • Weakness, lethargy, and irritability
  • Abdominal pain or swelling
  • Blood in urine or a discolored stream

It is important to note that some infants with PUVS may not show any symptoms at birth, but may develop them later on. In some cases, the condition may be discovered during routine prenatal ultrasounds.

Untreated PUVS can lead to serious complications, such as kidney damage, bladder damage, and urinary tract infections. It is important to seek medical attention if you or your child experience any of the symptoms associated with PUVS.

Diagnosis and Tests for Posterior Urethral Valves

If your child shows any symptoms of PUVS, it’s essential to seek medical attention promptly. Your doctor will perform a physical examination, including checking the abdomen for swelling and feeling for the bladder fullness. They may also order a series of diagnostic tests, such as:

  • Ultrasound of the kidneys and bladder
  • Cystoscopy to inspect the valve and urethra using a camera
  • Urodynamic study to measure changes in bladder pressure and urine flow when urinating
  • Radiography
  • Magnetic resonance urography (MRU)

It is important to note that early diagnosis and treatment of PUVS can prevent long-term complications such as kidney damage and urinary tract infections. In some cases, a prenatal ultrasound may detect PUVS before birth, allowing for early intervention. If your child is diagnosed with PUVS, your doctor will work with you to develop a treatment plan that may include surgery to remove the valve and improve urine flow.

The Role of Imaging in Diagnosing Posterior Urethral Valves

Imaging is an extremely valuable diagnostic tool when it comes to PUVS. Radiography can show the size of the bladder, location of the obstruction, and the presence of any complications, while MRU produces detailed images of the entire urinary tract to determine the extent of the obstruction.

In addition to radiography and MRU, ultrasound is also commonly used to diagnose PUVS. This non-invasive imaging technique can provide real-time images of the urinary tract, allowing doctors to visualize the obstruction and assess the function of the bladder and kidneys.

Imaging is not only useful for diagnosing PUVS, but also for monitoring the condition and evaluating the effectiveness of treatment. Regular imaging tests can help doctors track changes in the size of the bladder and kidneys, as well as identify any complications that may arise.

Treatment Options for Posterior Urethral Valve Syndrome

Once a diagnosis of PUVS is confirmed, management will depend on the severity of the condition. The treatment may include:

  • Catheterization: The placement of a catheter may help urologists to remove the excess urine in the bladder and diagnose the severity of the condition.
  • Medication: Antibiotics help clear infections. Also, medications may be prescribed to manage urinary retention and bladder incomplete emptying. Muscle relaxant meds help relieve an obstructed urethra.
  • Surgery: In more severe cases, the doctor may recommend surgical intervention to remove the valve, excise the urethral tissue, or reconstruct a segment of the urinary tract system. Such surgery is called urethroplasty.

In addition to the above treatment options, lifestyle changes may also be recommended to manage PUVS. These may include:

  • Drinking plenty of water to help flush out the urinary tract system.
  • Avoiding caffeine and alcohol, which can irritate the bladder and worsen symptoms.
  • Performing pelvic floor exercises to strengthen the muscles that support the bladder and urethra.
  • Managing constipation, as straining during bowel movements can put pressure on the bladder and worsen symptoms.

Recovery and Follow-up Care after Treatment

The postoperative care of patients with PUVS is crucial to minimize complications. Patients will require regular follow-up appointments to ensure that their urinary tract is functioning correctly and any infections are treated promptly. The length of the recovery period will depend on the severity of the condition and the type of surgery performed.

During the recovery period, patients may experience discomfort and pain. Pain medication may be prescribed to manage these symptoms. It is important for patients to follow the postoperative instructions provided by their healthcare provider, including proper wound care and activity restrictions.

In addition to follow-up appointments with their healthcare provider, patients with PUVS may also benefit from working with a physical therapist to improve bladder function and strengthen pelvic muscles. Dietary changes, such as increasing water intake and avoiding certain foods, may also be recommended to prevent future urinary tract infections.

Prevention Strategies for Posterior Urethral Valve Syndrome

While there is no known way to prevent PUVS from occurring, some steps can be taken to reduce the likelihood of your child developing the condition. These steps include:

  • Ensuring proper prenatal care and ultrasound scans during pregnancy
  • Early screening for any urinary problems in infants
  • Encouraging teenagers and adults to seek prompt medical attention for UTIs or abnormalities in the urinary tract or genital region

It is important to note that while prevention strategies can reduce the likelihood of PUVS, the condition can still occur even with proper care. If your child is diagnosed with PUVS, it is important to work closely with their healthcare team to develop a treatment plan that meets their individual needs.

Living with Posterior Urethral Valve Syndrome: Tips and Advice

For children living with PUVS, it’s essential to manage the condition appropriately to avoid complications and long-term damage to the urinary tract system. Tips and advice for living with PUVS may include:

  • Frequent monitoring for recurring symptoms and regular medical check-ups
  • Maintaining a low-salt and low-protein diet to preserve kidney function
  • Drinking plenty of fluids to ensure adequate hydration and urine production
  • Engaging in appropriate physical activity as recommended by your doctor

It is also important for parents and caregivers to be aware of the emotional impact that PUVS can have on children. Living with a chronic medical condition can be challenging, and children with PUVS may experience anxiety, depression, or social isolation. It is important to provide emotional support and resources to help children cope with the challenges of living with PUVS.

In addition, it is important to educate family members, teachers, and other caregivers about PUVS and how to manage the condition. This can help ensure that children with PUVS receive appropriate care and support in all settings, including at home, at school, and during social activities.


Posterior urethral valves are a rare urological condition that can result in significant complications if not appropriately managed. Parents and caregivers should be vigilant and seek prompt medical attention if they suspect their child is experiencing urinary problems. While treatment options vary depending on the severity of the condition, with prompt diagnosis and appropriate management, children with PUVS can lead healthy lives.

It is important to note that the long-term outcomes for children with PUVS can vary depending on the severity of the condition and the effectiveness of treatment. Some children may experience ongoing urinary problems or require additional surgeries, while others may have no long-term complications. Regular follow-up with a urologist is recommended to monitor the child’s urinary function and address any issues that may arise.

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