Posterior urethral valve is a disease seen in boys. It is a curtain-shaped structure in the tube (urethra)-shaped path that extends from the bladder to the tip of the pipi, which allows urination. This curtain makes it difficult for the urine to be discharged from the bladder during urination.
What is the reason for its formation?
It is thought that these curtains remain or form due to a problem during the formation of the structure we call the urethra during the formation of the baby's urinary tract at the beginning of pregnancy.
What is the incidence, are there different types?
Posterior urethral valve occurs once in 5000-8000 births. There are three types of PUVs. The most common type is the type called Type 1 with a rate of 90%. It gives an appearance as if they are combined at the top, like curtains gathered in the middle, and opened as they go down. However, the degree of actual obstruction affects the level of the problems in the patient.
What kind of complaints do they apply to the doctor?
Today, families often apply because of the enlargement of one or both kidneys of the baby during pregnancy, as at least two ultrasounds are performed during pregnancy. In addition to enlargement of the kidney, it can also give symptoms when the bladder is too large and does not empty the bladder during ultrasound. Often the bladder wall thickness is increased. After the baby is born, complaints such as inability to urinate fully, inability to urinate, and urinary tract infection are seen.
In patients with less obstruction, PUV manifests itself in advanced ages with symptoms such as urinary incontinence, weak urination or urinary tract infection.
How is the diagnosis made?
The diagnosis is made by urination cystourethrography performed after the baby is suspected by ultrasound taken while in the mother's womb. With the help of a catheter inserted into the bladder through the urethra, radio-opaque material is introduced into the bladder and films are taken during urination. It is investigated whether there is leakage towards the kidney (vesicoureteral reflux) and whether there is obstruction during voiding. In the films obtained with this examination, it is seen that most of the urine stays in the bladder, the part of the urethra before the valve, the bladder and the ureter and kidneys swell depending on the severity of the disease.
While the definitive diagnosis is made by cystoscopy, treatment is also done at the same time.
How is the treatment done?
What should be done in children with suspected PUV in the early or late period is to cut this valve with a closed method (endoscopic) as soon as possible. In this way, the bladder is filled and emptied normally. Closed surgery may need to be repeated several times. Therefore, these patients should be followed closely.
In cases where the bladder structure is severely impaired or the cystoscopy does not enter the pipi hole, vesicostomy surgery may be required. In an operation performed under general anesthesia, the bladder is mouthed to the skin so that the urine flows freely outward or into the gland. Thus, urine remains in the bladder and kidneys are prevented from being affected by pressure.
During the follow-up, it is necessary to observe how the children pee, to do the uroflow (voiding test) if possible, to follow up the urinary tract infection, to follow the kidney size and bladder wall thickness with ultrasound. It is also essential to monitor kidney functions.
It is also very important that these patients are followed up by pediatric nephrology.
What problems does it cause?
By causing urinary obstruction in babies, it can cause irreversible problems in kidney and bladder functions most of the time. Roughly 1/3 of the children with this disease are followed without any problems, 1/3 of them bladder and kidney problems require long-term follow-up with medication and intermittent catheterization, and the other 1/3 goes up to kidney failure. Therefore, it is a very important disease that should be followed closely.