Posterior urethral valves

Abstract

Despite advances in medical and surgical management of posterior urethral valves (PUVs), in the last few decades, 13–64 % of children still have chronic renal failure or end-stage renal disease (ESRD) at long-term follow-up. Prenatal diagnosis of PUVs has not yet improved this rate. The predictive value of the currently available prenatal parameters is still inaccurate and nonspecific to distinguish cases that may need prenatal intervention. In fact these parameters may help in detecting either the severe cases that may end by ESRD in early infancy or the mild affected cases with normal amniotic fluid, normal renal parenchyma on ultrasound, and normal fetal blood and urine biochemical markers. Today it is still unclear to predict the cases that are in the grey area in between these two extremes. Current long-term results of prenatally detected PUVs confirm that early endoscopic valves ablation can be considered as the primary treatment in the majority of cases without the need of diversion. One of the major consequences of PUVs is the deterioration of bladder function. Active management of these bladders needs a close follow-up and invasive investigations by pediatric urologists. Most of these bladders can be managed without further surgery, and bladder augmentation became an exceptional surgical option that is needed only after using all the available reversible tools including clean intermittent catheterization and anticholinergic treatment for poor compliant bladders. PUVs are again one of these pediatric urology pathologies for which long-term follow-up of renal and bladder functions had given us more clear insights and underlined the absolute need for multidisciplinary management and lifelong follow-up.