Posterior urethral valves
At Children’s Hospital Boston, we know that an early and accurate diagnosis is the key for successful treatment and long-term management of posterior urethral valves (PUV).
When are PUV detected?
How early PUV can be detected usually depends on the severity of the condition:
- In severe cases, PUV may be identified during pregnancy through an ultrasound, a non-invasive imagining technique that uses sound waves to generate an image of the fetus.
- Serious symptoms of PUV such as hydronephrosis (build up of urine in the kidney) can show up on this prenatal ultrasound.
- A dilated kidney-collecting system or dilated ureter (the tube that goes from the kidney up above to the bladder below) in a male fetus can alert doctors to a possible diagnosis of PUV
Mild and moderate cases
- In mild to moderate cases of PUV, fetal imaging may look relatively normal.
- In these cases, PUV can have a gradual effect on the bladder and therefore go undetected for years until the child is older and presents with symptoms.
- In this case, a diagnosis is made after a series of diagnostics tests are performed.
How is PUV diagnosed?
Although findings from prenatal tests can make doctors suspect PUV, a formal diagnosis can only made after the baby is born.
A definitive diagnosis of PUV is made using:
- Voiding cystourethrogram (VCUG), a minimally invasive test that uses special x-ray technology to examine the urinary tract and bladder.
- During this procedure, a radiologist will gently slide a very small catheter (tube) coated with numbing gel into your child’s urethra and into the bladder.
- The tube will be used to fill the bladder with a contrast material that illuminates the urinary tract by using x-ray images.
- Using fluoroscopy, a special x-ray technique, the radiologist will obtain images of your child's bladder during filling and emptying.
- The images from a VCUG can be used to:
- diagnose vesicoureteral reflux: the reverse flow of urine into the ureters and kidneys, and how well the bladder empties.
- determine why your child has recurring urinary tract infections
- discover if antibiotic treatment or anti-reflux surgery was effective
- determine if there are any abnormalities or obstructions in the urethra
Other tests used to evaluate a boy with PUV include:
- direct endoscopic visualization (cystourethroscopy), a test that uses an endoscope (a small flexible telescopic tubewith a light and a camera lens at the end) to examine the urethra.
- blood tests to check for abnormalities such as elevated creatinine, a waste product that the body makes each day. Since it can only leave the body through the kidneys, a high creatinine level in the blood is a sign of decreased kidney functioning.
- urodynamic study (UDS) which involvesevaluation of bladder storage and emptying function.
Learn more about the different methods that Children’s uses to diagnose urinary issues such as PUV.
|A medical approach to end wetting|
|Carlos Estrada, MD, a urologist and director of the Voiding Improvement Program at Children’s, discusses the unique treatments and techniques used to help children with voiding issues. Learn more by reading this article on bed-wetting posted on Thriving, Children’s pediatric health blog|