Posterior urethral valves

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Posterior urethral valves

Renal system


Posterior urethral valves


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Posterior urethral valves

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Posterior urethral valve p. 549


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Posterior urethral valve, or PUV, is a congenital disorder in boys where the posterior urethra, which is the section of the urethra nearest the bladder, is obstructed by membranous folds, or flaps of tissue. These flaps of tissue are collectively referred to as a congenital obstructive posterior urethral membrane, or COPUM.

This blockage means urine can’t easily flow out, which leads to a backup of urine which can cause kidney problems, as well as less amniotic fluid which can cause respiratory problems.

Although the cause of PUV isn’t completely understood, it’s thought that normal development of the male urethra is disrupted between weeks 9 and 14 of gestation.

Normal development involves the Wolffian duct integrating with the posterior urethra, which results in thin mucosal folds called plicae colliculi.

It’s thought that PUV might result from abnormal integration of the wolffian duct, resulting in large plicae colliculi that fuse anteriorly, making it more difficult for urine to flow through.

When that urine can’t easily flow out because of increased resistance from an obstruction, the intravesical pressure, or bladder pressure, starts to creep up.

Holding urine under higher pressure leads to bladder wall hypertrophy and collagen deposition, both of which thicken the bladder wall. This thickening makes the bladder less compliant, meaning that small increases in urine volume causes large increases in bladder pressure, which makes the problem even worse.

That high-pressure urine has nowhere to go but up to the ureters and eventually to the kidneys, causing hydronephrosis, which is the swelling of a kidney due to a buildup of urine.


Posterior urethral valves (PUV), also referred to as congenital obstructive posterior urethral membrane, is a urologic disorder affecting boys where membranous folds obstruct the normal flow of urine. This leads to bladder outlet obstruction, causing high bladder pressure that causes vesicoureteral reflux. The reflux of urine back up into the ureters and kidneys leads to urinary stasis, which can lead to recurrent urinary tract infections; and hydronephrosis, which is the swelling of a kidney due to a buildup of urine. Treatment involves surgery and ablation of the membrane, which allows urine to flow through unobstructed.


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