Posterior urethral valves
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Posterior urethral valves
Renal system
Renal and ureteral disorders
Metabolic acidosis
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Acute tubular necrosis
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Alport syndrome
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Renal system pathology review
Acid-base disturbances: Pathology review
Congenital renal disorders: Pathology review
Electrolyte disturbances: Pathology review
Kidney stones: Pathology review
Nephritic syndromes: Pathology review
Nephrotic syndromes: Pathology review
Renal and urinary tract masses: Pathology review
Renal failure: Pathology review
Renal tubular acidosis: Pathology review
Renal tubular defects: Pathology review
Urinary incontinence: Pathology review
Urinary tract infections: Pathology review
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Posterior urethral valves
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External References
First Aid
2017
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.
Summary
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.
Sources
- "Robbins Basic Pathology" Elsevier (2017)
- "Harrison's Principles of Internal Medicine, Twentieth Edition (Vol.1 & Vol.2)" McGraw-Hill Education / Medical (2018)
- "Pathophysiology of Disease: An Introduction to Clinical Medicine 8E" McGraw-Hill Education / Medical (2018)
- "CURRENT Medical Diagnosis and Treatment 2020" McGraw-Hill Education / Medical (2019)
- "Aggressive diagnosis and treatment for posterior urethral valve as an etiology for vesicoureteral reflux or urge incontinence in children" Investigative and Clinical Urology (2017)
- "Antenatal oligohydramnios of renal origin: long-term outcome" Nephrology Dialysis Transplantation (2006)
- "Posterior Urethral Obstruction: COPUM" Bangladesh Journal of Endosurgery (2014)
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