Posterior Urethral Valves  (PUV)

What is posterior urethral valves?

Posterior urethral valves (PUV) are extra flaps of tissue in the urethra, the tube that carries urine out of the body. It's a condition that occurs only in boys.

PUVs block the flow of urine from the bladder out of the body. This can cause the urine to back up in the bladder, ureters, and kidneys causing severe swelling. Over time, the swelling can damage these organs. The condition can range from mild to severe, depending on how much of the urine flow is blocked.

PUV is a condition that a baby is born with, called a congenital condition. It is sometimes diagnosed before your baby is born on prenatal ultrasound checks.

What are the signs and symptoms of a PUV?

If PUVs are diagnosed during a prenatal ultrasound, possible signs may include an enlarged bladder or swelling in the kidneys. There may also be less fluid than normal around your baby.

After your baby is born, symptoms of PUV may include:

• Repeated urinary tract infections
• A weak stream of urine
• Difficulty urinating
• Urinary accidents
• Swelling of the kidneys (hydronephrosis) and the ureters
• Thickened bladder

In mild cases, boys may not have symptoms for a few years. In severe cases, newborns may have problems with the bladder, kidneys or lungs shortly after birth.

What causes a PUV?

Experts don't know what causes PUVs. They develop in the early stages of pregnancy. In some cases, they can run in families, which may point to a genetic cause.

How are PUVs treated?

Your child’s treatment for a PUV will depend on how severe his condition is. The Division of Urology at Arkansas Children’s is experienced in diagnosing and treating PUVs and will work with you to come up with the best treatment plan for your child.

If there is a concern that a child has PUV, an imaging test using a urinary catheter and XRAY, called a voiding cystourethrogram, is performed. The results of this test will determine if your son needs surgery to correct PUV. Your child's specific treatment will depend on his age, size, and severity of the condition. Possible treatment options may include:

• Valve ablation. During this procedure, the surgeon uses a small device with a light and a camera at the end to look into the urethra. The surgeon can then make cuts into the PUV so it no longer blocks the urethra.
• Vesicostomy: This procedure is used when there is a severe blockage or when the baby is too small for a valve ablation. In a vesicostomy, the surgeon creates an opening from the bladder to the outside of the belly so the urine can drain freely into a diaper. The opening can later be closed.

Boys diagnosed with PUV are followed by the Urology and Nephrology team as they age to monitor their bladder and kidney health. Arkansas Children's offers families seen by both of these teams the opportunity for coordinated visits, often in a joint clinic called the Urology-Nephrology (Uro-Neph) Clinic.