Posterior Urethral Valves
Posterior urethral valves or PUVs, are a rare congenital defect that only occurs in infants assigned male at birth. It is a condition wherein extra flaps of tissues grow in the urethra- the tube through which urine exits the urinary tract. These extra urethral tissues prevent the proper flow of urine from the bladder to the tip of the penis and out of the body. When there is no proper expelling of urine from the body, the organs within the urinary tract get dilated and there is serious damage to tissues and cells within them. Thus, there could be damage to the kidneys, urethra, ureters, or urinary bladder.
Posterior urethral valves are also known by the name congenital obstructing (or obstructive) posterior urethral membrane (COPUM).
Arete Hospitals is a preferred choice for Posterior Urethral Valve (PUV) Surgery treatment in Hyderabad due to its renowned urology department, experienced surgeons, state-of-the-art facilities, and a track record of successful urological procedures. Patients can expect high-quality care and specialised expertise for PUV surgery at Arete Hospitals.
Benefits of Posterior Urethral Valves Treatment
- PUV surgery helps to clear blockages in the urethra, allowing better urine flow, reducing the risk of urinary tract infections and kidney damage.
- Removing the valves protect the kidneys from long-term damage, ensuring they can function optimally
- PUV surgery in Hyderabad can improve bladder function, reducing issues like urinary incontinence
- Surgery can prevent complications like bladder diverticula and ureteral reflux, which may arise due to untreated PUV
- By addressing PUV early through surgery, individuals can lead healthier lives with reduced urinary problems and kidney-related issues.
Causes of Posterior Urethral Valves
Posterior Urethral Valves are thought to develop when the baby is in the mother’s womb- specifically in the early stages of development of the foetus. They are seen only in male infants, about 1 in 8,000 births. Such a condition is sporadic, meaning it occurs by chance. However, in some cases like in twins and siblings, a genetic component may be the cause.
Normally, the urethra has small flaps of tissues. The researchers suspect that at the time of foetal development, the body signals the urethral tissues to stop growing or helps in the reduction of these tissues. Male infants with posterior urethral valves have their urethral tissues growing in size because the signals have never been sent or picked up.
Signs and Symptoms of Posterior Urethral Valves
The symptoms of PUV may vary among the patients based on their severity. In the case of mild PUVs, the symptoms usually do not appear until the child is aged 10 years or above. Before any symptoms appear, PUV can be identified in the child by the use of prenatal imaging. If there is hydronephrosis identified, it is a more severe case, and so the child is monitored both during pregnancy and after birth. After childbirth, further medical imaging studies can confirm the diagnosis.
Children who are diagnosed with PUV later may present the following signs and symptoms:
- Urinary tract infection (most common)
- Dysuria- pain felt while urinating
- Weak urine stream
- Wetting pants or bedwetting even after the child is trained to use the toilet
- Difficulty in passing urine- new onset or urinary incontinence
- Poor weight fluctuations in infants
- Kidney failure.
It is important that one must consult a Paediatric Urologist near me, if their newborn is diagnosed with PUV. As initial treatment can ensure one’s good health.
Diagnosis of Posterior Urethral Valves
Before childbirth, the doctor may use an ultrasound to diagnose PUV. The doctor may even use ultrasound afterward to monitor the condition of the patient. In case, the child is suspected to have PUVs, the doctor may perform a series of tests. These include:
- A renal ultrasound- It is done to detect any obstruction or mass in the kidneys or urinary tract.
- Cystoscopy- It involves the use of a cystoscope to get a detailed view of the inside of the urinary tract.
- Voiding cystourethrogram- It involves placing the catheter in the urinary bladder and instilling a contrast dye. This is followed by the use of X-ray to see direct images of the ureters and bladder.
- Blood test- It is carried out to check how well the child’s kidneys are working.
Posterior Urethral Valves Treatment in Hyderabad
The treatment of posterior urethral valves depends upon the severity of the child’s condition. The extent of damage caused to the organs of the urinary tract depends upon how badly the urethra is obstructed and how late is the condition diagnosed in the child.
In very few circumstances, the Posterior Urethral Valves Doctor in Hyderabad may suggest surgery during pregnancy. This especially happens when in the ultrasound the foetus is detected to have oligohydramnios, meaning there is a low amount of amniotic fluid.
Surgery
The most commonly performed treatment for the posterior urethral valve is minor and minimally invasive surgery to remove the blocking urethral valve. This surgical procedure is known as endoscopic incision of the valves or urethral valve ablation. During this operation, the doctor inserts a cystoscope- a tube with a camera and light at one end, into the urethra of the child. After locating the extra flaps of tissues, the doctor ablates the valve through a small incision at the site of removal of the valves.
If the newborn boy has dilated kidneys- a hydronephrosis condition, then he may need the following surgeries:
- Urinary diversion- It is the procedure designed to divert the flow of urine before it reaches the urethra. To help drain urine directly into the diaper, the doctor may suggest a vesicostomy. A vesicostomy is an operation done to create a small opening in the urinary bladder through the patient’s abdomen. This is performed in male infants having more severe cases of PUVs, where they may need to use a urinary catheter to empty the bladder at times. It is beneficial for male infants with severe PUV who are too young for endoscopic valve ablation surgery.
- Proximal diversion- It is a less commonly performed surgical procedure wherein the ureter of the patient is brought out (diverted) to the skin to allow urine to flow to the side of the body (the body’s proximal). This is beneficial only for boys having more severe disease presentations. For instance, they have very thick walls of their urinary bladder, or their bladder has marked abnormalities.
Medication
The treatment of PUVs would also involve prescribing medications to treat urinary tract infections or to relax the muscles of the urinary bladder. There is no specific medication known to treat posterior urethral valves.
Medications may be given by the doctor in addition to the surgery to treat more severe problems. This includes stiffening of the bladder muscles because of severe hyperactivity of the muscles. Certain medications such as antis-pas-motics, antic-holiner-gics, and sympat-hom-imetics can help relax and soften the muscles of the urinary bladder.
For more details on Posterior Urethral Valves (PUV) Cost in Hyderabad, consult the experts at Arete Hospitals.
Complications of Untreated Posterior Urethral Valves
If Posterior Urethral valves are left untreated for long, they may lead to the following complications:
- Impaired renal function and high risk of kidney failure
- Hydronephrosis- stretched-out kidneys due to dilation
- Respiratory distress
- Urinary retention because of non-emptying of the urinary bladder completely (bladder dysfunction in newborns)
- Vesicoureteral reflux- urine flow gets backward into the body instead of flowing out of the body.
What follow-up care is needed after surgery for PUV?
Following the surgery, the patient may still experience mild symptoms of urinary incontinence, urgency, and frequency. Such symptoms can often be cured with a simple outpatient procedure. In case of serious impact on a child’s urinary tract, the child may need extensive reconstructive surgery to prevent kidney damage. The parent of the child needs to be in close contact with the son’s physician so that the son can be closely monitored by the physician for any signs of developing problems. Boys with PUVs need to have ongoing medical management. They need to be closely monitored for their kidney and bladder functioning as well as voiding ability.
There are male infants with severe PUV causing urine reflux. In such patients, the black flow of urine into the kidneys results in gradual damage to the kidneys and ultimately kidney failure. The doctor would recommend a urodynamic study for such male infants to evaluate their urinary bladder and monitor for urine reflux after 6 months of valve ablation. This approach can provide specific information about the urinary bladder such as its capacity, detrusor muscles, storage pressure, and emptying or urinary bladder.
Is PUV curable?
The surgical repair of the obstruction involved in posterior urethral valves does not completely cure the condition.
Can I prevent PUV?
Posterior Urethral Valves develop in children before their birth and so you cannot prevent them from happening. Even if the doctor can diagnose this condition before the birth of the child, treatment is provided right after birth. If PUV is not diagnosed early, rarely the patient could survive till adulthood.
For more details pay a visit at Arete Hospitals, Best Posterior Urethral Valve Treatment Hospital in Hyderabad.
