Before birth: Detected during a routine antenatal ultrasound showing a distended bladder, bilateral hydronephrosis (swelling of kidneys), or if the kidneys are dysplastic in severe cases then - oligohydramnios (reduced amniotic fluid).
In newborns: Poor urine stream, urinary retention, abdominal distension, or urinary tract infection (UTI).
In infants or older children: Repeated UTIs, poor growth, weak urinary stream, or symptoms related to chronic kidney disease.
Diagnosis
If PUV is suspected, the following investigations help confirm the diagnosis:
Ultrasound of kidneys, ureters, and bladder (KUB): Shows thickened bladder wall, Dilated Posterior Urethra – Key hole Sign, dilated ureters, and hydronephrosis.
MCU (Micturating Cystourethrogram): A contrast study of the bladder and urethra, this is the definitive test showing the dilated posterior urethra and irregular shaped bladder with or without VUR.
Blood tests: To assess kidney function (urea, creatinine).
Management and Treatment
Management depends on the severity of obstruction and kidney function:
Initial Stabilization
Catheterization: To relieve bladder pressure temporarily and assess urine output.
Antibiotics: For treatment or prevention of infection.
Monitoring kidney function and hydration status.
Definitive Treatment: Endoscopic Valve Ablation
This is the gold standard treatment.
A pediatric urologist or surgeon uses a small cystoscope to visualize the valve and cut it using electrocautery or a cold knife.
This relieves the obstruction and allows normal urine flow.
In severe cases
If the renal functions are deteriorating
Recurrent UTI’s
Other options of Urinary diversion may be required like Vesicostomy or Ureterostomy
Follow-up and Long-term Care
Regular follow-up is essential to monitor kidney function and bladder health.
Urodynamic studies may be required in children with persistent voiding issues.
In some cases, children may need ongoing medications for bladder dysfunction or support for chronic kidney disease.
Outlook
With early diagnosis and appropriate treatment, many children with PUV can lead healthy lives. However, some may face long-term kidney or bladder issues. Timely intervention and careful follow-up can make a significant difference in outcomes.
If your child has been diagnosed with PUV or is showing signs of urinary obstruction, consult a pediatric urologist or pediatric surgeon early.
Early treatment prevents complications and improves kidney outcomes.
