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Posterior Urethral Valves
Karen Y. Oh, MD
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KEY FACTS

  • Terminology

    • Imaging

      • Top Differential Diagnoses

        • Pathology

          • Clinical Issues

            • Diagnostic Checklist

              TERMINOLOGY

              • Abbreviations

                • Posterior urethral valves (PUV)
                • Lower urinary tract obstruction (LUTO)
              • Definitions

                • Urethral membrane acts as valve, resulting in LUTO
                  • Obstruction is usually partial
                  • Posterior urethra obstructed by valves
                  • Occurs exclusively in males

              IMAGING

              • General Features

                • Ultrasonographic Findings

                  • MR Findings

                    • Imaging Recommendations

                      DIFFERENTIAL DIAGNOSIS

                        PATHOLOGY

                        • General Features

                          • Gross Pathologic & Surgical Features

                            • Microscopic Features

                              CLINICAL ISSUES

                              • Presentation

                                • Demographics

                                  • Natural History & Prognosis

                                    • Treatment

                                      DIAGNOSTIC CHECKLIST

                                      • Consider

                                        • Image Interpretation Pearls

                                          Selected References

                                          1. Smith-Harrison LI et al: Current applications of in utero intervention for lower urinary tract obstruction. J Pediatr Urol. 11(6): 341-7, 2015
                                          2. Sarhan OM et al: Did antenatal diagnosis protect against chronic kidney disease in patients with posterior urethral valves? A multicenter study. Urology. 82(6):1405-9, 2013
                                          3. Ansari MS et al: Risk factors for progression to end-stage renal disease in children with posterior urethral valves. J Pediatr Urol. 6(3):261-4, 2010
                                          4. Kohl T: Minimally invasive fetoscopic interventions: an overview in 2010. Surg Endosc. 24(8):2056-67, 2010
                                          5. Wells JM et al: Urinomas protect renal function in posterior urethral valves--a population based study. J Pediatr Surg. 45(2):407-10, 2010
                                          6. Bernardes LS et al: Keyhole sign: how specific is it for the diagnosis of posterior urethral valves? Ultrasound Obstet Gynecol. 34(4):419-23, 2009
                                          7. Heikkilä J et al: Urinomas associated with posterior urethral valves. J Urol. 180(4):1476-8, 2008
                                          8. Kousidis G et al: The long-term outcome of prenatally detected posterior urethral valves: a 10 to 23-year follow-up study. BJU Int. 102(8):1020-4, 2008
                                          9. Sarhan O et al: Long-term outcome of prenatally detected posterior urethral valves: single center study of 65 cases managed by primary valve ablation. J Urol. 179(1):307-12; discussion 312-3, 2008
                                          10. Schreuder MF et al: Posterior urethral valves in three siblings: a case report and review of the literature. Birth Defects Res A Clin Mol Teratol. 82(4):232-5, 2008
                                          11. Lissauer D et al: Fetal lower urinary tract obstruction. Semin Fetal Neonatal Med. 12(6):464-70, 2007
                                          12. Robyr R et al: Correlation between ultrasound and anatomical findings in fetuses with lower urinary tract obstruction in the first half of pregnancy. Ultrasound Obstet Gynecol. 25(5):478-82, 2005
                                          13. Eckoldt F et al: Posterior urethral valves: prenatal diagnostic signs and outcome. Urol Int. 73(4):296-301, 2004
                                          14. Vanderheyden T et al: Fetal renal impairment. Semin Neonatol. 8(4):279-89, 2003
                                          15. Holmes N et al: Fetal surgery for posterior urethral valves: long-term postnatal outcomes. Pediatrics. 108(1):E7, 2001
                                          16. Herndon CD et al: Consensus on the prenatal management of antenatally detected urological abnormalities. J Urol. 164(3 Pt 2):1052-6, 2000
                                          17. Freedman AL et al: Fetal therapy for obstructive uropathy: diagnosis specific outcomes [corrected] J Urol. 156(2 Pt 2):720-3; discussion 723-4, 1996
                                          18. Crombleholme TM et al: Fetal intervention in obstructive uropathy: prognostic indicators and efficacy of intervention. Am J Obstet Gynecol. 162(5):1239-44, 1990
                                          19. Mahony BS et al: Fetal renal dysplasia: sonographic evaluation. Radiology. 152(1):143-6, 1984
                                          Related Anatomy
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                                          Related Differential Diagnoses
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                                          References
                                          Tables

                                          Tables

                                          KEY FACTS

                                          • Terminology

                                            • Imaging

                                              • Top Differential Diagnoses

                                                • Pathology

                                                  • Clinical Issues

                                                    • Diagnostic Checklist

                                                      TERMINOLOGY

                                                      • Abbreviations

                                                        • Posterior urethral valves (PUV)
                                                        • Lower urinary tract obstruction (LUTO)
                                                      • Definitions

                                                        • Urethral membrane acts as valve, resulting in LUTO
                                                          • Obstruction is usually partial
                                                          • Posterior urethra obstructed by valves
                                                          • Occurs exclusively in males

                                                      IMAGING

                                                      • General Features

                                                        • Ultrasonographic Findings

                                                          • MR Findings

                                                            • Imaging Recommendations

                                                              DIFFERENTIAL DIAGNOSIS

                                                                PATHOLOGY

                                                                • General Features

                                                                  • Gross Pathologic & Surgical Features

                                                                    • Microscopic Features

                                                                      CLINICAL ISSUES

                                                                      • Presentation

                                                                        • Demographics

                                                                          • Natural History & Prognosis

                                                                            • Treatment

                                                                              DIAGNOSTIC CHECKLIST

                                                                              • Consider

                                                                                • Image Interpretation Pearls

                                                                                  Selected References

                                                                                  1. Smith-Harrison LI et al: Current applications of in utero intervention for lower urinary tract obstruction. J Pediatr Urol. 11(6): 341-7, 2015
                                                                                  2. Sarhan OM et al: Did antenatal diagnosis protect against chronic kidney disease in patients with posterior urethral valves? A multicenter study. Urology. 82(6):1405-9, 2013
                                                                                  3. Ansari MS et al: Risk factors for progression to end-stage renal disease in children with posterior urethral valves. J Pediatr Urol. 6(3):261-4, 2010
                                                                                  4. Kohl T: Minimally invasive fetoscopic interventions: an overview in 2010. Surg Endosc. 24(8):2056-67, 2010
                                                                                  5. Wells JM et al: Urinomas protect renal function in posterior urethral valves--a population based study. J Pediatr Surg. 45(2):407-10, 2010
                                                                                  6. Bernardes LS et al: Keyhole sign: how specific is it for the diagnosis of posterior urethral valves? Ultrasound Obstet Gynecol. 34(4):419-23, 2009
                                                                                  7. Heikkilä J et al: Urinomas associated with posterior urethral valves. J Urol. 180(4):1476-8, 2008
                                                                                  8. Kousidis G et al: The long-term outcome of prenatally detected posterior urethral valves: a 10 to 23-year follow-up study. BJU Int. 102(8):1020-4, 2008
                                                                                  9. Sarhan O et al: Long-term outcome of prenatally detected posterior urethral valves: single center study of 65 cases managed by primary valve ablation. J Urol. 179(1):307-12; discussion 312-3, 2008
                                                                                  10. Schreuder MF et al: Posterior urethral valves in three siblings: a case report and review of the literature. Birth Defects Res A Clin Mol Teratol. 82(4):232-5, 2008
                                                                                  11. Lissauer D et al: Fetal lower urinary tract obstruction. Semin Fetal Neonatal Med. 12(6):464-70, 2007
                                                                                  12. Robyr R et al: Correlation between ultrasound and anatomical findings in fetuses with lower urinary tract obstruction in the first half of pregnancy. Ultrasound Obstet Gynecol. 25(5):478-82, 2005
                                                                                  13. Eckoldt F et al: Posterior urethral valves: prenatal diagnostic signs and outcome. Urol Int. 73(4):296-301, 2004
                                                                                  14. Vanderheyden T et al: Fetal renal impairment. Semin Neonatol. 8(4):279-89, 2003
                                                                                  15. Holmes N et al: Fetal surgery for posterior urethral valves: long-term postnatal outcomes. Pediatrics. 108(1):E7, 2001
                                                                                  16. Herndon CD et al: Consensus on the prenatal management of antenatally detected urological abnormalities. J Urol. 164(3 Pt 2):1052-6, 2000
                                                                                  17. Freedman AL et al: Fetal therapy for obstructive uropathy: diagnosis specific outcomes [corrected] J Urol. 156(2 Pt 2):720-3; discussion 723-4, 1996
                                                                                  18. Crombleholme TM et al: Fetal intervention in obstructive uropathy: prognostic indicators and efficacy of intervention. Am J Obstet Gynecol. 162(5):1239-44, 1990
                                                                                  19. Mahony BS et al: Fetal renal dysplasia: sonographic evaluation. Radiology. 152(1):143-6, 1984