Posterior Urethral Valves

  • Mario De GennaroEmail author
  • Maria Luisa Capitanucci
  • Giovanni Mosiello
  • Antonio Zaccara
Part of the Urodynamics, Neurourology and Pelvic Floor Dysfunctions book series (UNPFD)


Posterior urethral valves represent a congenital condition, with a prevalence of 2.48 per 10,000 live births, which very often deals with bladder problems. It is one of the main issues of clinical urodynamic in children.

A great proportion of patients suffer from urinary incontinence, and bladder dysfunction was seen in many of them (55%, 0–72%) after primary treatment. Despite early relief of obstruction, pathological changes in the bladder can cause bladder dysfunction and consequent progressive slow deterioration of the upper urinary tract drainage with renal failure, possibly leading to renal insufficiency over years. Thus, prevention and treatment of bladder dysfunction, based on urodynamic observations, are mandatory in terms of long-term outcome. Over time abnormal urodynamic patterns of myogenic failure, detrusor overactivity, and decreased compliance/small capacity (so-called valve bladder) may develop. In addition, urodynamic bladder function may change with time, leading with myogenic failure in some postpubertal patients, most likely secondary to increased urine production and persistence of functional bladder neck outlet obstruction impairment.

Nowadays, differently than in the past when aggressive surgical approaches were claimed, a conservative management was shown more effective and safe, following primary neonatal valves ablation. An accurate and early toilet training program, a strict follow-up mainly based on not invasive urodynamic evaluations, and an advanced urotherapy program with associate appropriate drugs therapy are effective to prevent and treat bladder dysfunction in children with urethral valves. The cases leading with renal insufficiency, polyuria, upper urinary tract deterioration, and, ultimately, kidney transplant need more aggressive investigations and treatments.


Urethral valves Bladder Urethra Congenital anomalies Urinary obstruction Children Urodynamics Bladder dysfunction Urinary anomalies 


  1. 1.
    Malin G, Tonks AM, Morris RK, et al. Congenital lower urinary tract obstruction: a population-based epidemiological study. BJOG. 2012;119:1455–64.CrossRefPubMedCentralPubMedGoogle Scholar
  2. 2.
    Clark TJ, Martin WL, Divakaran TG, et al. Prenatal bladder drainage in the management of fetal lower urinary tract obstruction: a systematic review and meta-analysis. Obstet Gynecol. 2003;102:367–82.PubMedPubMedCentralGoogle Scholar
  3. 3.
    Pluto Collaborative Study Group, Kilby M, Khan K, Morris K, et al. PLUTO trial protocol: percutaneous shunting for lower urinary tract obstruction randomised controlled trial. BJOG. 2007;114:904–5.CrossRefGoogle Scholar
  4. 4.
    Sarhan O, El-Ghoneimi A, Hafez A. Surgical complications of posterior urethral valve ablation: 20 years experience. J Pediatr Surg. 2010;45:2222–6.CrossRefPubMedCentralPubMedGoogle Scholar
  5. 5.
    Mandal S, Goel A, Kumar M, et al. Use of holmium YAG laser in posterior urethral valves: another method of fulguration. J Pediatr Urol. 2013;9:1093–7.CrossRefPubMedCentralPubMedGoogle Scholar
  6. 6.
    Pagano MJ, van Batavia JP, Casale C. Ablation in the management of obstructive uropathy in neonates. J Endourol. 2015;29(5):611–4.CrossRefPubMedCentralPubMedGoogle Scholar
  7. 7.
    Nanda M, Bawa M, Narasimhan KL. Mini-vesicostomy in the management of PUV after valve ablation. J Pediatr Urol. 2012;8:51–4.CrossRefPubMedCentralPubMedGoogle Scholar
  8. 8.
    Narasimhan KL, Kaur B, Chowdhary SK, et al. Does mode of treatment affect the outcome of neonatal posterior urethral valves? J Urol. 2004;171:2423–6.CrossRefPubMedCentralPubMedGoogle Scholar
  9. 9.
    Kim YH, Horowitz M, Combs A, et al. Comparative urodynamic findings after primary valve ablation, vesicostomy or proximal diversion. J Urol. 1996;156:673.CrossRefPubMedCentralPubMedGoogle Scholar
  10. 10.
    Parkhouse HF, Barrat TM, Dillon MJ, et al. Long-term outcome of boys with posterior urethral valves. BJU Int. 1988;62:59.CrossRefGoogle Scholar
  11. 11.
    Ghanen MSA, Wolffenbuttel KP, Vylder A, et al. Long-term bladder dysfunction and renal function in boys with posterior urethral valves based on urodynamic findings. J Urol. 2004;171:2409–12.CrossRefGoogle Scholar
  12. 12.
    Ansari MS, Gulia A, Srivastava A, et al. Risk factors for progression to end-stage renal disease in children with posterior urethral valves. J Pediatr Urol. 2010;6:261–4.CrossRefPubMedCentralPubMedGoogle Scholar
  13. 13.
    De Gennaro M, Capitanucci ML, Mosiello G, et al. The changing urodynamic pattern from infancy to adolescence in boys with posterior urethral valves. BJU Int. 2000;85:1104.CrossRefPubMedCentralPubMedGoogle Scholar
  14. 14.
    Androulakakis PA, Karamanolakis DK, Tsahouridis G, et al. Myogenic bladder decompensation in boys with a history of posterior urethral valves is caused by secondary bladder neck obstruction? BJU Int. 2005;96(1):140–3.CrossRefPubMedCentralPubMedGoogle Scholar
  15. 15.
    Glassberg KI. The severe bladder dysfunction: 20 years later. J Urol. 2001;166:1406–10.CrossRefPubMedCentralPubMedGoogle Scholar
  16. 16.
    Kajbafzadeh A, Payabvash S, Karimian G, et al. The effects of bladder neck incision on urodynamic abnormalities of children with posterior urethral valves. J Urol. 2007;178:2142–9.CrossRefPubMedCentralPubMedGoogle Scholar
  17. 17.
    De Gennaro M, Mosiello G, Capitanucci ML, et al. Early detection of bladder dysfunction following posterior urethral valve ablation. Eur J Pediatr Surg. 1996;6:163.CrossRefPubMedCentralPubMedGoogle Scholar
  18. 18.
    De Gennaro M, Capitanucci ML, Capozza N, et al. Detrusor hypocontractility in children with posterior urethral valves arises before puberty. Br J Urol. 1998;81:81.CrossRefPubMedCentralPubMedGoogle Scholar
  19. 19.
    Nevéus T, von Gontard A, Hoebeke P, et al. The standardization of terminology of lower urinary tract function in children and adolescents: report from the Standardisation Committee of the International Children’s Continence Society. J Urol. 2006;176:314.CrossRefPubMedCentralPubMedGoogle Scholar
  20. 20.
    Bael A, Lax H, De Jong TP, et al. The relevance of urodynamic studies for urge syndrome and dysfunctional voiding: a multicenter controlled trial in children. J Urol. 2008;180:1486.CrossRefPubMedCentralPubMedGoogle Scholar
  21. 21.
    Capitanucci ML, Marciano A, Zaccara A, et al. Long-term bladder function followup in boys with posterior urethral valves: comparison of noninvasive vs invasive urodynamic studies. J Urol. 2012;188:953–7.CrossRefPubMedCentralPubMedGoogle Scholar
  22. 22.
    Kim YH, Horowitz M, Combs AJ, et al. Management of posterior urethral valves on the basis of urodynamic findings. J Urol. 1997;158:1011.CrossRefPubMedCentralPubMedGoogle Scholar
  23. 23.
    Jessica TC, Jennifer AH, Max M, et al. Early administration of oxybutynin improves bladder function and clinical outcomes in newborns with posterior urethral valves. J Urol. 2012;188:1516–20.CrossRefGoogle Scholar
  24. 24.
    Misseri R, Combs AJ, Horowitz M, et al. Myogenic failure in posterior urethral valve disease: real or imagined? J Urol. 2002;168:1844–7.CrossRefPubMedCentralPubMedGoogle Scholar
  25. 25.
    Abraham MK, Nasir AR, Sudarsanan B, et al. Role of alpha adrenergic blocker in the management of posterior urethral valves. Pediatr Surg Int. 2009;25:1113–5.CrossRefPubMedCentralPubMedGoogle Scholar
  26. 26.
    Mokhless I, Zahran AR, Saad A, et al. Effect of Botox injection at the bladder neck in boys with bladder dysfunction after valve ablation. J Pediatr Urol. 2014;10:899–905.CrossRefPubMedCentralPubMedGoogle Scholar
  27. 27.
    Sarhan OM, El-Ghoneimi AA, Helmy TE, et al. Posterior urethral valves: multivariate analysis of factors affecting the final renal outcome. J Urol. 2011;185:2491–5.CrossRefPubMedCentralPubMedGoogle Scholar
  28. 28.
    Ghanem MA, Wolffenbuttel KP, De Vylder A, et al. Long-term bladder dysfunction and renal function in boys with posterior urethral valves based on urodynamic findings. J Urol. 2004;171:2409–12.CrossRefPubMedCentralPubMedGoogle Scholar
  29. 29.
    Fast AM, Nees SN, Van Batavia JP, et al. Outcomes of vesicoureteral reflux in children with non-neurogenic lower urinary tract dysfunction with targeted treatment at their specific LUT condition. J Urol. 2013;190:1028–33.CrossRefPubMedCentralPubMedGoogle Scholar
  30. 30.
    Tourchi A, Kajbafzadeh AM, Aryan Z, et al. The management of vesicoureteral reflux in the setting of posterior urethral valve with emphasis on bladder function and renal outcome: a single center cohort study. Urology. 2014;83(1):199–205.CrossRefPubMedCentralPubMedGoogle Scholar
  31. 31.
    Hunziker M, Mohanan N, D’Asta F, et al. Incidence of febrile urinary tract infections in children after successful endoscopic treatment of vesicoureteral reflux: a long-term follow-up. J Pediatr. 2012;160:1015–20.CrossRefPubMedCentralPubMedGoogle Scholar
  32. 32.
    Yohannes P, Hanna M. Current trends in the management of posterior urethral valves in the pediatric population. Urology. 2002;60(6):947e53.CrossRefGoogle Scholar
  33. 33.
    Dinneen MD, Duffy PG, Barrat TM, et al. Persistent polyuria after posterior urethral valves. BJU Int. 1995;75:236–40.CrossRefGoogle Scholar
  34. 34.
    Koff SA, Mutabagani K, Jayanthi VR. The valve bladder syndrome: pathophysiology and treatment with nocturnal bladder emptying. J Urol. 2002;167:291–7.CrossRefPubMedCentralPubMedGoogle Scholar
  35. 35.
    Hale JM, Wood DN, Hoh IM, et al. Stabilization of renal deterioration caused by bladder volume dependent obstruction. J Urol. 2009;182:1973–7.CrossRefPubMedCentralPubMedGoogle Scholar
  36. 36.
    Reinberg Y, Gonzalez R, Fryd D, et al. The outcome of renal transplantation in children with posterior urethral valves. J Urol. 1988;140:1491.CrossRefPubMedCentralPubMedGoogle Scholar
  37. 37.
    Pippi Salle JL, Jesus LE. Pre-transplant management of valve bladder: a critical literature review. J Pediatr Urol. 2015;11:5–11.CrossRefPubMedCentralPubMedGoogle Scholar
  38. 38.
    Wühl E, Schaefer F. Therapeutic strategies to slow chronic kidney disease progression. Pediatr Nephrol. 2008;22:705–16.CrossRefGoogle Scholar
  39. 39.
    Woodhouse CR, Reilly JM, Bahadur G. Sexual function and fertility in patients treated for posterior urethral valves. J Urol. 1989;142:586–8.CrossRefPubMedCentralPubMedGoogle Scholar
  40. 40.
    Lopez Pereira P, Miguel M, Martinez Urrutia MJ, et al. Long-term bladder function, fertility and sexual function in patients with posterior urethral valves treated in infancy. J Pediatr Urol. 2013;9:38–41.CrossRefPubMedCentralPubMedGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  • Mario De Gennaro
    • 1
    Email author
  • Maria Luisa Capitanucci
    • 1
  • Giovanni Mosiello
    • 2
  • Antonio Zaccara
    • 1
  1. 1.Division of Urology, Surgery for Continence and UrodynamicsBambino Gesù Children HospitalRomeItaly
  2. 2.Pediatric NeuroUrology Research and ClinicBambino Gesù Children HospitalRomeItaly

Personalised recommendations