Obstructing Urethral Valve in a Woman: A Case Report

Abstract

We report on a woman with a urethral valve causing obstruction, hyperreflexia, vesicoureteral reflux and retention. The diagnosis of urethral valves in female subjects rests on endoscopy and radiographic studies. Transurethral resection of the valve is effective treatment. The literature is discussed briefly.

Obstructing urethral membrane in a girl: a rare cause of female bladder outlet obstruction

“…The proposed theories for posterior urethral valve (PUV) in males include malformations of the inferior urethral crest and fins,2 and failure of the Wolffian ducts to properly integrate into the urethra, resulting in a membrane 3. The incidence of obstructing urethral membranes (OUMs) in females has been mentioned by a few authors only in the past 2 4 5. The lower incidence in females could be due to the absence of an analogous structure in the female urethra.…”

“…He proposed that more proximal obstructions are mostly acquired rather than congenital 1. According to Hendren, urethral valves in females are of three types: (1) true valves, (2) postoperative remnants of ectopic ureteroceles and (3) valves arising from a rudimentary verumontanum in girls, with adrenogenital syndrome and masculinisation of the lower urinary tract 4. Accordingly, several anatomical variations have been described including transverse bands and longitudinal urethral folds, some of which may be delivered into the urethra 2 4.…”

“…According to Hendren, urethral valves in females are of three types: (1) true valves, (2) postoperative remnants of ectopic ureteroceles and (3) valves arising from a rudimentary verumontanum in girls, with adrenogenital syndrome and masculinisation of the lower urinary tract 4. Accordingly, several anatomical variations have been described including transverse bands and longitudinal urethral folds, some of which may be delivered into the urethra 2 4. Complete obstructions are confused with urethral atresia and result in mortality unless they drain into a patent urachus, empty into the vagina, uterus or colon,1 6 or antenatal interventions have been done 7…”

“…Unlike in males, the female urethra is shorter and more distensible, thereby more easily accessible to treatment 1. Olive tip bougies, skenoscopes and cystourethroscopes have been employed to hook the membrane and section it under vision (transurethral excision) 2 4 6. This works well for distally placed membranes, while those that are thicker or closer to the bladder neck require endoscopic management.…”