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Pediatrics
Diagnosis
Genitourinary
Congenital Urinary Tract Abnormalities
Posterior Urethral Valves
Posterior Urethral Valves
Sara M. O'Hara, MD, FAAP
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KEY FACTS

  • Terminology

    • Imaging

      • Top Differential Diagnoses

        • Clinical Issues

          TERMINOLOGY

          • Abbreviations

            • Posterior urethral valves (PUV)

          • Definitions

            • PUV: Varying degrees of chronic urethral obstruction due to fusion &/or prominence of plicae colliculi (which are normal concentric folds within posterior urethra)
            • Valve bladder: Varying degrees of urinary bladder dysfunction secondary to chronic bladder obstruction

          IMAGING

          • General Features

            • Radiographic Findings

              • Fluoroscopic Findings

                • Ultrasonographic Findings

                  • MR Findings

                    • Nuclear Medicine Findings

                      • Other Modality Findings

                        • Imaging Recommendations

                          DIFFERENTIAL DIAGNOSIS

                            PATHOLOGY

                            • General Features

                              • Staging, Grading, & Classification

                                • Gross Pathologic & Surgical Features

                                  • Microscopic Features

                                    CLINICAL ISSUES

                                    • Presentation

                                      • Demographics

                                        • Natural History & Prognosis

                                          • Treatment

                                            Selected References

                                            1. Expert Panel on Pediatric Imaging et al: ACR Appropriateness Criteria® antenatal hydronephrosis-infant. J Am Coll Radiol. 17(11S):S367-79, 2020
                                            2. Guha Vaze P et al: Urodynamics in posterior urethral valve: pursuit of prognostication or optimisation. J Pediatr Urol. (1):111.e1-8, 2020
                                            3. Jain P et al: A rare association of posterior urethral valve with anterior urethral valve, large anterior urethral diverticula, and glanular hypospadias. J Endourol Case Rep. 6(4):362-5, 2020
                                            4. Lee B et al: PUVs are more common in boys with hypospadias. J Pediatr Urol. 16(3):299-303, 2020
                                            5. Manyevitch R et al: Adolescent presentation of posterior urethral valves. Urology. 136:e1-2, 2020
                                            6. Shekar PA et al: "When ablation goes wrong"- urethral strictures after ablation of posterior urethral valves-characteristics, management and outcomes". J Pediatr Urol. 16(6):843.e1-9, 2020
                                            7. Vinit N et al: Fetal cystoscopy and vesicoamniotic shunting in lower urinary tract obstruction: long-term outcome and current technical limitations. Fetal Diagn Ther. 47(1):74-83, 2020
                                            8. Brownlee E et al: Current epidemiology and antenatal presentation of posterior urethral valves: outcome of BAPS CASS National Audit. J Pediatr Surg. 54(2):318-21, 2019
                                            9. Lundar L et al: Prenatal extravasation of urine seems to preserve renal function in boys with posterior urethral valves. J Pediatr Urol. 15(3):241.e1-7, 2019
                                            10. Wagemans MEHM et al: Cowper's syringocele in the pediatric population: a retrospective study of 122 patients. J Pediatr Urol. 15(5):546-51, 2019
                                            11. Farrugia MK et al: Report on The Society for Fetal Urology panel discussion on the selection criteria and intervention for fetal bladder outlet obstruction. J Pediatr Urol. 13(4):345-51, 2017
                                            12. Pellegrino M et al: Prenatal detection of megacystis: not always an adverse prognostic factor. Experience in 25 consecutive cases in a tertiary referral center, with complete neonatal outcome and follow-up. J Pediatr Urol. 13(5):486.e1-10, 2017
                                            13. Bilgutay AN et al: Posterior urethral valves: risk factors for progression to renal failure. J Pediatr Urol. 12(3):179.e1-7, 2016
                                            14. Sananes N et al: Two-year outcomes after diagnostic and therapeutic fetal cystoscopy for lower urinary tract obstruction. Prenat Diagn. 36(4):297-303, 2016
                                            15. Coleman R et al: Nadir creatinine in posterior urethral valves: how high is low enough? J Pediatr Urol. 11(6):356.e1-5, 2015
                                            16. Jesus LE et al: Pre-transplant management of valve bladder: a critical literature review. J Pediatr Urol. 11(1):5-11, 2015
                                            17. Clayton DB et al: Lower urinary tract obstruction in the fetus and neonate. Clin Perinatol. 41(3):643-59, 2014
                                            18. Ruano R et al: Fetal intervention for severe lower urinary tract obstruction: a multicenter case-control study comparing fetal cystoscopy with vesico-amniotic shunting. Ultrasound Obstet Gynecol. 45(4):452-8, 2014
                                            19. Thakkar D et al: Epidemiology and demography of recently diagnosed cases of posterior urethral valves. Pediatr Res. 76(6):560-3, 2014
                                            20. Lopez Pereira P et al: Long-term consequences of posterior urethral valves. J Pediatr Urol. 9(5):590-6, 2013
                                            21. 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
                                            22. Fine MS et al: Posterior urethral valve treatments and outcomes in children receiving kidney transplants. J Urol. 185(6 Suppl):2507-11, 2011
                                            23. Krishnan A et al: The anatomy and embryology of posterior urethral valves. J Urol. 175(4):1214-20, 2006
                                            24. McMann LP et al: Magnetic resonance urography in the evaluation of prenatally diagnosed hydronephrosis and renal dysgenesis. J Urol. 176(4 Pt 2):1786-92, 2006
                                            25. Mercado-Deane MG et al: US of renal insufficiency in neonates. Radiographics. 22(6):1429-38, 2002
                                            26. Kraus SJ: Genitourinary imaging in children. Pediatr Clin North Am. 48(6):1381-424, 2001
                                            27. Fernbach SK et al: Pediatric voiding cystourethrography: a pictorial guide. Radiographics. 20(1):155-68; discussion 168-71, 2000
                                            Related Anatomy
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                                            Related Differential Diagnoses
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                                            References
                                            Tables

                                            Tables

                                            KEY FACTS

                                            • Terminology

                                              • Imaging

                                                • Top Differential Diagnoses

                                                  • Clinical Issues

                                                    TERMINOLOGY

                                                    • Abbreviations

                                                      • Posterior urethral valves (PUV)

                                                    • Definitions

                                                      • PUV: Varying degrees of chronic urethral obstruction due to fusion &/or prominence of plicae colliculi (which are normal concentric folds within posterior urethra)
                                                      • Valve bladder: Varying degrees of urinary bladder dysfunction secondary to chronic bladder obstruction

                                                    IMAGING

                                                    • General Features

                                                      • Radiographic Findings

                                                        • Fluoroscopic Findings

                                                          • Ultrasonographic Findings

                                                            • MR Findings

                                                              • Nuclear Medicine Findings

                                                                • Other Modality Findings

                                                                  • Imaging Recommendations

                                                                    DIFFERENTIAL DIAGNOSIS

                                                                      PATHOLOGY

                                                                      • General Features

                                                                        • Staging, Grading, & Classification

                                                                          • Gross Pathologic & Surgical Features

                                                                            • Microscopic Features

                                                                              CLINICAL ISSUES

                                                                              • Presentation

                                                                                • Demographics

                                                                                  • Natural History & Prognosis

                                                                                    • Treatment

                                                                                      Selected References

                                                                                      1. Expert Panel on Pediatric Imaging et al: ACR Appropriateness Criteria® antenatal hydronephrosis-infant. J Am Coll Radiol. 17(11S):S367-79, 2020
                                                                                      2. Guha Vaze P et al: Urodynamics in posterior urethral valve: pursuit of prognostication or optimisation. J Pediatr Urol. (1):111.e1-8, 2020
                                                                                      3. Jain P et al: A rare association of posterior urethral valve with anterior urethral valve, large anterior urethral diverticula, and glanular hypospadias. J Endourol Case Rep. 6(4):362-5, 2020
                                                                                      4. Lee B et al: PUVs are more common in boys with hypospadias. J Pediatr Urol. 16(3):299-303, 2020
                                                                                      5. Manyevitch R et al: Adolescent presentation of posterior urethral valves. Urology. 136:e1-2, 2020
                                                                                      6. Shekar PA et al: "When ablation goes wrong"- urethral strictures after ablation of posterior urethral valves-characteristics, management and outcomes". J Pediatr Urol. 16(6):843.e1-9, 2020
                                                                                      7. Vinit N et al: Fetal cystoscopy and vesicoamniotic shunting in lower urinary tract obstruction: long-term outcome and current technical limitations. Fetal Diagn Ther. 47(1):74-83, 2020
                                                                                      8. Brownlee E et al: Current epidemiology and antenatal presentation of posterior urethral valves: outcome of BAPS CASS National Audit. J Pediatr Surg. 54(2):318-21, 2019
                                                                                      9. Lundar L et al: Prenatal extravasation of urine seems to preserve renal function in boys with posterior urethral valves. J Pediatr Urol. 15(3):241.e1-7, 2019
                                                                                      10. Wagemans MEHM et al: Cowper's syringocele in the pediatric population: a retrospective study of 122 patients. J Pediatr Urol. 15(5):546-51, 2019
                                                                                      11. Farrugia MK et al: Report on The Society for Fetal Urology panel discussion on the selection criteria and intervention for fetal bladder outlet obstruction. J Pediatr Urol. 13(4):345-51, 2017
                                                                                      12. Pellegrino M et al: Prenatal detection of megacystis: not always an adverse prognostic factor. Experience in 25 consecutive cases in a tertiary referral center, with complete neonatal outcome and follow-up. J Pediatr Urol. 13(5):486.e1-10, 2017
                                                                                      13. Bilgutay AN et al: Posterior urethral valves: risk factors for progression to renal failure. J Pediatr Urol. 12(3):179.e1-7, 2016
                                                                                      14. Sananes N et al: Two-year outcomes after diagnostic and therapeutic fetal cystoscopy for lower urinary tract obstruction. Prenat Diagn. 36(4):297-303, 2016
                                                                                      15. Coleman R et al: Nadir creatinine in posterior urethral valves: how high is low enough? J Pediatr Urol. 11(6):356.e1-5, 2015
                                                                                      16. Jesus LE et al: Pre-transplant management of valve bladder: a critical literature review. J Pediatr Urol. 11(1):5-11, 2015
                                                                                      17. Clayton DB et al: Lower urinary tract obstruction in the fetus and neonate. Clin Perinatol. 41(3):643-59, 2014
                                                                                      18. Ruano R et al: Fetal intervention for severe lower urinary tract obstruction: a multicenter case-control study comparing fetal cystoscopy with vesico-amniotic shunting. Ultrasound Obstet Gynecol. 45(4):452-8, 2014
                                                                                      19. Thakkar D et al: Epidemiology and demography of recently diagnosed cases of posterior urethral valves. Pediatr Res. 76(6):560-3, 2014
                                                                                      20. Lopez Pereira P et al: Long-term consequences of posterior urethral valves. J Pediatr Urol. 9(5):590-6, 2013
                                                                                      21. 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
                                                                                      22. Fine MS et al: Posterior urethral valve treatments and outcomes in children receiving kidney transplants. J Urol. 185(6 Suppl):2507-11, 2011
                                                                                      23. Krishnan A et al: The anatomy and embryology of posterior urethral valves. J Urol. 175(4):1214-20, 2006
                                                                                      24. McMann LP et al: Magnetic resonance urography in the evaluation of prenatally diagnosed hydronephrosis and renal dysgenesis. J Urol. 176(4 Pt 2):1786-92, 2006
                                                                                      25. Mercado-Deane MG et al: US of renal insufficiency in neonates. Radiographics. 22(6):1429-38, 2002
                                                                                      26. Kraus SJ: Genitourinary imaging in children. Pediatr Clin North Am. 48(6):1381-424, 2001
                                                                                      27. Fernbach SK et al: Pediatric voiding cystourethrography: a pictorial guide. Radiographics. 20(1):155-68; discussion 168-71, 2000