Treatments for Posterior Urethral Valves (PUV)

If your son was born with a posterior urethral valve (PUV)—a form of bladder obstruction—he’ll need surgery to remove the blockage. He’ll also need ongoing care to make sure the blockage doesn’t have any long-term impact on his bladder or kidneys. 

Although it’s natural to feel worried when your child has a medical condition, you can take comfort in knowing the PUV experts from Cincinnati Children’s are here to help.

We offer all the treatments and monitoring your son may need throughout infancy, childhood and adolescence. And, if needed, we can help him transition from pediatric to adult urology care once he reaches adulthood.

Treatments Tailored to Your Child’s Needs

There isn’t a one-size-fits-all treatment for PUV. Instead, we create a customized care plan based on several factors, including:

• Age at diagnosis. We diagnose and coordinate treatment for some children while they’re still in the womb, and treat others later in childhood when symptoms first appear. Our patients’ follow-up schedules vary based on their age and the severity of any kidney or bladder complications. For example, we recommend more frequent monitoring during infancy and the teen years because children in these two age groups are more vulnerable to kidney damage.
• Severity of the blockage. Compared to a partial blockage, a complete blockage is more likely to cause significant bladder or kidney damage. 
• Potential complications. Some children with PUV have urinary reflux into their kidneys (when urine flows backward from the bladder to the kidneys). Others may be unable to fully empty their bladder. These patients may need treatments to prevent complications such as frequent urinary tract infections (UTIs). 
• Your son’s overall health and quality of life. PUV can lead to medical problems like high blood pressure or delayed growth and development. It also can cause bedwetting, daytime accidents or toilet training challenges.

All children with PUV need surgery to remove the blockage. Others also may need treatments such as medicine, catheterization (draining the bladder) and supportive behavioral therapy. 

PUV Surgery: Endoscopic Surgery and More

The main surgical treatment for PUV is called cystoscopy.

Cystoscopy is a type of endoscopic surgery that lets us access the urinary tract without making any incisions (surgical cuts). Instead, we pass a cystoscope (small tube with a light and camera attached) through the urethra, which is the tube that carries urine from the bladder to outside the body.

During the procedure, your son’s surgeon passes tiny surgical tools through the cystoscope to cut the PUV and remove the obstruction.

Some young children who cannot empty their bladders also may need surgery that temporarily helps their bladder drain. We offer:

• Vesicostomy. We create a new passageway that lets urine flow from the bladder through an opening in the belly.
• Ureterostomy. With this procedure, we reroute urine flow using one or both ureters (a pair of tubes that connects the bladder to the kidneys). We disconnect the ureter(s) from the bladder and reconnect them to an opening in the belly.

These drainage surgeries usually are reversed when children begin toilet training.

Catheterization

Catheterization is a nonsurgical option for some children who can’t fully empty their bladder. It allows a patient to drain the urine from his bladder at regular intervals throughout the day. This helps prevent problems that can occur when the bladder never completely empties, such as UTIs and urinary incontinence (urine leakage due to loss of bladder control).

With catheterization, you—or your child, if they’re old enough—guide a lubricated catheter (tiny tube) through the urethra until it reaches the bladder. Urine flows through the catheter and into the toilet or a collection container. Once the bladder is empty, the catheter is removed.

Catheterization can be a temporary or long-term treatment.

Medication Options for Children With PUV

Patients who often get (or are at risk for) UTIs may need to take medication to prevent or treat them. That’s because frequent UTIs can damage the bladder and kidneys.

Some types of medications we commonly prescribe include:

• Antibiotics that help prevent UTIs when a low, daily dose is used long-term
• Anticholinergics that relax the bladder muscles
• Alpha blockers that improve bladder emptying

Additional Services for Patients with PUV

At the PUV Center, we partner with other Cincinnati Children’s experts to ensure patients receive complete medical, social and emotional support. Whether your son needs help coping with his condition or managing his kidney health, you can count on our team to provide it.