Posterior urethral valves

Infobox_Disease
Name = PAGENAME


Caption =
DiseasesDB = 34137
ICD10 =
ICD9 =
ICDO =
OMIM =
MedlinePlus =
eMedicineSubj = ped
eMedicineTopic = 2357
eMedicine_mult = eMedicine2|radio|572
MeshID =

Posterior urethral valves are an obstructive congenital defect of the male urethra. [cite journal | author = Manzoni C, Valentini A | title = Posterior urethral valves. | journal = Rays | volume = 27 | issue = 2 | pages = 131–4 | year = | pmid = 12696266]

Classification

Posterior urethral obstruction was first classified by Hugh Hampton Young, urology pioneer, in 1919. More recent evidence suggests that obstruction in the posterior urethra is a COPUM (Congenital Obstructive Posterior Urethral Membrane), while the fibrous obstructive anomalies in the more distal urethra are remnants of the urogenital membrane, also called Cobb's Collar. These are equivalent to Young's type III lesions, which are not in the posterior urethra.

Diagnosis

*Abdominal ultrasound is of some benefit, but not diagnostic. Features that suggest posterior urethral valves are:
**Bilateral hydronephrosis.
**Thickened bladder wall
**Bladder diverticula
*Voiding cystourethrogram (VCUG) - diagnostic

Complications

*Incontinence
*Urinary tract infection
*Renal failure
*Vesicoureteral reflux

Treatment

There are three treatments of the posterior urethral valves:
*Vesicostomy and then valve ablation - making a stoma (a hole) in the urinary bladder, also known as "high diversion", followed by closure of the stoma and valve abalation.
*Pyelostomy and then valve ablation - making a stoma (a hole) in the pelvis of the kidney, also known as "high diversion", followed by closure of the stoma and valve abalation.
*Primary (transurethral) Valve ablation - removal of the valves through urethra, without stoma.

The standard treatment is primary (transurethral) ablation of the valves.Warren J, Pike JG, Leonard MP. Posterior urethral valves in Eastern Ontario - a 30 year perspective. Can J Urol. 2004 Apr;11(2):2210-5. PMID 15182412.] Urinary diversion is used in selected cases, and its benefit is disputed. [Kim YH, Horowitz M, Combs A, Nitti VW, Libretti D, Glassberg KI. Comparative urodynamic findings after primary valve ablation, vesicostomy or proximal diversion. J Urol. 1996 Aug;156(2 Pt 2):673-6. PMID 8683757.] Smith GH, Canning DA, Schulman SL, Snyder HM 3rd, Duckett JW. The long-term outcome of posterior urethral valves treated with primary valve ablation and observation. J Urol. 1996 May;155(5):1730-4. PMID 8627873.]

Female homolog

The female homolog to the male verumontanum from which the valves originate is the hymen.

References