POSTERIOR URETHRAL VALVE DISEASE

Abstract

Abstract

Introduction: Posterior urethral valves are congenital disorders characterized by infravesical obstruction

resulting in widespread damage and dysfunction of the entire urinary tract. In this review, embryology,

clinical features, management alternatives and prognosis of this pathology are discussed.

Classically, three distinct types of posterior urethral valves were classified by Young. Despite their

different embryological origin, there is no clear difference in their clinical picture. Overall, Type I urethral

valves make up more than 90% of the lesions, and are generally accepted to be the end result of anomalous

insertion of the mesonephric ducts into the primitive fetal cloaca. Clinical picture generally depends on age at

presentation. Ultrasonography is the mainstay in the diagnosis, while catheterization and drainage of the

bladder is the initial step recommended in the management of posterior urethral valves. Voiding

cystourethrograms document the prostatic urethra, and the degree of hydronephrosis and presence of

vesicourethral reflux, which is associated with poor prognosis.

Management of posterior urethral valves also depends on the age at presentation as well as the degree of

renal insufficiency, and aims to improve bladder dynamics in order to minimize and reverse the detrimental

effects on the kidney. Despite advanced treatment alternatives, including prenatal manipulations, prognosis is

generally poor and 10-30% of cases develop end-stage renal failure.