IS Case 616: PUV - Posterior urethral valves
Imaging Sciences URMC 2011
Publication Date: 2011-12-12
History
Patient is a 1-day-old male, with severe respiratory distress at birth, whose mother was of advanced maternal age with polyhydramnios, and positive group B streptococcus (GBS) culture.
Findings
Posterior urethra is dilated with a sharp transition to a non-dilated anterior urethra separated by a well-defined transverse lucency consistent with posterior urethral valves. Contrast refluxes bilaterally into dilated tortuous ureters. It reaches a dilated collecting system on the right but not on the left.
Discussion
Posterior urethral valves (PUV) occur exclusively in males. PUV are a common and serious cause of congenital bladder outlet obstruction in males. They can present in utero, in the neonate, later in childhood, and even in adults. PUV represents a spectrum of severity. The degree of obstruction caused by this abnormality widely varies depending on the configuration of the obstructive membrane within the urethra. PUV is the most common cause of lower urinary tract obstruction in male neonates; the reported incidence is 1 per 8,000 to 1 per 25,000 live births. Diagnosis is usually made before or at birth when a boy is evaluated for antenatal hydronephrosis. Renal and bladder ultrasonography, voiding cystourethrography and renal scintigraphy are used to evaluate patients. Surgical treatment includes using postnatal primary valve ablation, vesicostomy and cutaneous ureterostomies.
References
- Macpherson RI, Leithiser RE, Gordon L, Turner WR. Posterior urethral valves: an update and review. Radiographics. 1986 Sep;6(5):753-91. PMID: 3317550
- Wiener JS, Gaca AM, Sekula J. Posterior urethral valve imaging. eMedicine-Medscape. Updated: May 25, 2011. http://emedicine.medscape.com/article/412226-overview
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