POSTERIOR URETHRAL VALVE

1. DR.PRITESH B PATEL
MBBS, MD (PEDIA), FIAP (NEONATOLOGIST)
NEOCARE NICU AND CHILDREN HOSPITAL , NAVSARI,
GUJARAT

2.  1:5000 in live male births
 Most common congenital BOT obstruction
 No genetic / environment / maternal factors

3.  Anomalous insertion of mesonephric duct
into uro-genital sinus, preventing normal
migration of ducts and anterior fusion as a
consequence of n annormality of the cloacal
membrane
 Membrane to attached posteriorly, just distal
to verumontanum
 Membrane extended anteriorly and obliquely
beyond external sphincter

4.  Number of cases of PUV increased
 UK – scan atleast 2 times
 - 10-12 week and 20 week
 ½- 2/3rd diagnosed antenatally.
 USG finding
 Thick wall bladder
 Keyhole sign
 U/L or B/L hydroureteonephrosis
 Echogenic kidney
 oligohydromnios

5.  D/D
 Prune belly syndrome
 Urethral atresis
 B/L VUR
 Megacystic microcolon intestine
 Poor prognostic indicator
 Echogenic bladder
 oligohydramnios

6.  Current options being
 Serial vesicocentesis
 Vesico amniotic shunting
 IU valve ablation
 Who benefit by intervation done
 Fetal urine analysis
 Urine osmolarity(<200mOsm/kg)
 Na+(<100mg/dl)/Ca+(<8mg/dl) concentration
 B-2 microglobulin(<4mg/L)
 Protein(20mg/dl)

7.  (1)renal scan-size and quality of parenchyma
-degree of hydroureteronephrosis
-Bladder wall thickness
 (2)MCU-confirm diagnosis
 Demostrate- posterior urethral dialated,
open neck bladder, irragular bladder, VUR
 Additional- bladder size,thickenng,
trabeculation, diverticulation
 (3)renal scan- function of kidney and
obstruction

9.  (1)priority –drain bladder with 6fr catheter
-Antibiotic prophylaxis
 Closed watch to U/O and electrolyte
 (2)if oligohydramnios + pulmonary hypoplasia

10.  Primary valve ablation- bugbee elecrode/
cord /sicle blade resection at 5,7,12 o’clock
 Urethral catheter for 2-3 days
 S.creat after 2 daays with U/O monitoring
and renal supplements
 Complications of Sx
 Bleeding, incomplete
ablation,stricture,damage external sphincter
 For preterm
 Delay treatment untill weight 2.5kg

11.  All male f’up cysyocsopy within 3 month of
Sx
 (poor correlation of repeat MCU in diagnosing
residual valve)

12.  different institute- different regimn
 Objective – maximize renal function,
minimixe UTI/renal scarring
 Asseessment and managgement of voiding
disfunction

13.  Early urinary diversion
 small group of male do not respond to
standerd treatment, renal function remain
fragile, recurrent UTI
 Reflux ureterostomy