The posterior urethral valves revisited: embryological correlation, clinical classification, and risk stratification of the spectrum

Abstract

Background The diagnosis of posterior urethral valves (PUV) encompasses a vast spectrum of disease with variable severity and clinical features. It is vital to understand the extent of developmental insult and to define the different distinct entities grouped together under the diagnostic umbrella of PUV. This would help to determine the severity of the disease, enable better prognostication, and optimize therapy. The objective of this study is to analyze the variable features of PUV and correlate the different manifestations with the embryological development of the urinary system. The possible developmental basis of anomalies in PUV is analyzed, as recognition of the underlying defect would help to determine the severity of the disease. A clinical classification and a risk stratification approach encompassing the spectrum of PUV is proposed, to help define diagnosis and guide prognosis. A combined retrospective and prospective analysis of cases diagnosed as PUV at the tertiary teaching institute over a 5-year period from July 2014 to July 2019 was done. The outcome of selected cases was analyzed, based on the risk group stratification. Results The incidence of major complications during follow-up in each risk group was assessed individually and found to be highest in the high-risk group (92%), which was significantly higher than the other groups. The intermediate risk group was found to have a complication rate of 38%, while the low-risk group had only 12.5% complication rate. The three key concepts addressed in this study pertain to the embryological basis of PUV, the necessity of a clinical subdivision of patients, and the possibility of risk stratification based on clinical criteria. The limited review of institutional series is added to highlight the method of risk stratification and its probable utility. Conclusions The most critical factors to be accounted for in the diagnosis and management of PUV are the definition of disease severity, recognition of systemic complications, and identification of children at risk of progression to ESRD. The proposed developmental defect analysis, description of PUV sequence, clinical classification, and risk stratification approach are only the means to this end of segregating patient groups within the diagnostic spectrum.

Effects of oxybutynin in children with posterior urethral valves post fulguration

“…[ 10 ] However, a recent report from India shows that 76% ( n = 78/102) have been detected antenatally, which is higher than what we have reported. [ 11 ] This is probably due to the changing antenatal care policies in our country where the government is incentivizing pregnant mothers to seek professional antenatal care at designated hospitals and primary health care centers. [ 12 ] The most common presenting complaints in our study were poor urinary stream (55.56%) and recurrent UTI (41.67%).…”

Posterior urethral valve and ureterocele in a neonate: A rare association

“…Posterior urethral valve and ureterocele in a neonate: A rare association Journal of Pediatric and Adolescent Surgery | 2021 | 2 |Page 2 newborn males with a reported incidence of 1 in 4000 to 8000 pregnancies. [1][2][3][4] Usually, the posterior urethral valve presents as an isolated developmental renal anomaly and rarely presents in association with renal anomalies like the Unicaliceal kidney, partial urethral duplication, and scaphoid megalourethra. [5][6][7] A review of the literature suggests that cryptorchidism remains the most common and ureterocele remains the rarest associated anomaly in a patient with a posterior urethral valve.…”

“…The posterior urethral valve is one of the most common causes of lower urinary tract obstruction in neonates and usually presents as an isolated anomaly. [1][2][3][4] The development of the ureterocele in presence of a posterior urethral valve appears to be extremely uncommon owing to different embryological development and the presence of a high-pressure bladder. [1,2,4] The simultaneous occurrence of ureterocele and posterior urethral valves has no embryological linkage and should be construed as unrelated events.…”

“…[1][2][3][4] The development of the ureterocele in presence of a posterior urethral valve appears to be extremely uncommon owing to different embryological development and the presence of a high-pressure bladder. [1,2,4] The simultaneous occurrence of ureterocele and posterior urethral valves has no embryological linkage and should be construed as unrelated events. [1,2] The present case appears to be the third case of this rare association to be reported in English literature to date.…”

Posterior Urethral Valves; Outcome Analysis after Endoscopic Valve Ablation

“…Posterior urethral valves (PUV) are one of the commonest causes of chronic renal failure (CRF) and end-stage renal disease (ESRD) in male children. 1 It is the most common congenital anomaly of lower urinary tract in boys causing bladder outlet obstruction with an incidence of 1 in 5000 to 8000 live male births. Posterior urethral valve was first described in 1717 by Morgagni and later by Langenbeck in 1802.…”