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Posterior Urethral Valve (PUV) Care — Neonatal to Childhood Management
Posterior urethral valve (PUV) is a serious congenital condition that obstructs the bladder outlet in boys and can affect both urinary and renal health. At Swastik Urology Clinic in Gomti Nagar Extension, Lucknow, we provide prompt neonatal stabilisation, evidence-based definitive treatment (endoscopic valve ablation) and long-term bladder and kidney care under the expertise of Dr. Aditya Sengar (Urologist). Our focus is to decompress obstruction quickly, treat infection, and support kidney growth and bladder function over time.
Why early diagnosis matters
Early identification of PUV—sometimes seen on antenatal ultrasound as bilateral hydronephrosis—allows timely intervention to prevent worsening renal damage. Rapid decompression reduces the risk of urinary sepsis and progressive loss of kidney function. Even after valve ablation, many children need lifelong monitoring for bladder dysfunction and renal sequelae.
Typical clinical features
Newborns may present with poor urinary output, abdominal distension, respiratory distress due to bladder distension, or urinary tract infection. Older infants and children present with recurrent febrile UTIs, poor growth, dribbling urine, or failure to thrive.
Key diagnostic tests
Ultrasound of the kidneys and bladder is the first-line imaging. MCU/VCUG (micturating cystourethrogram) confirms PUV by showing dilated posterior urethra and reflux/voiding abnormality. Urine culture, renal function tests (serum creatinine, electrolytes), and DMSA/renogram may be needed to assess renal scarring and function.
Immediate stabilisation steps
Stabilisation includes bladder catheterisation to decompress the urinary tract, appropriate intravenous antibiotics for infection, fluid and electrolyte management, and planning for definitive treatment when stable.
Definitive & supportive treatments
Endoscopic Valve Ablation (Fulguration)—the standard definitive procedure—uses a paediatric cystoscope to visualise and remove the obstructing valves. Temporary urinary diversion (vesicostomy or percutaneous nephrostomy) is used when the baby is unstable or when renal drainage must be achieved urgently. After decompression, bladder rehabilitation, infection prevention and renal monitoring form the core of long-term care.
Bladder and renal follow-up — an essential part of care
Many children with PUV develop bladder dysfunction — decreased compliance, overactivity or incomplete emptying — which can persist despite successful valve ablation. We provide structured bladder follow-up including timed voiding, management of constipation, pelvic floor therapy where needed, medications (anticholinergics or alpha-blockers), and clean intermittent catheterisation in selected children. Renal surveillance with ultrasound, DMSA scan and serum tests helps detect scarring or progressive dysfunction early. Children with chronic kidney disease require multidisciplinary care with paediatric nephrology and long-term blood pressure and growth monitoring.
When is urinary diversion needed?
Urinary diversion (temporary vesicostomy or nephrostomy) is considered when the child is too small or unstable for safe endoscopic ablation, if there is severe upper tract obstruction or infection requiring urgent drainage, or when bladder drainage cannot be achieved by catheterisation alone. Diversion is usually temporary and reversed once the child is stable and definitive treatment is possible.
Why choose Swastik Urology Clinic for PUV care?
Swastik Urology Clinic offers paediatric-focused urology care:
• Prompt neonatal stabilisation and coordinated emergency care.
• Expertise in paediatric endoscopic procedures—safe valve ablation with paediatric cystoscopes.
• Experience with temporary diversion techniques when indicated.
• Structured long-term bladder rehabilitation programs and close renal monitoring.
• Multidisciplinary approach involving paediatricians, nephrologists and physiotherapists for optimal growth, kidney protection and quality of life.
• Prompt neonatal stabilisation and coordinated emergency care.
• Expertise in paediatric endoscopic procedures—safe valve ablation with paediatric cystoscopes.
• Experience with temporary diversion techniques when indicated.
• Structured long-term bladder rehabilitation programs and close renal monitoring.
• Multidisciplinary approach involving paediatricians, nephrologists and physiotherapists for optimal growth, kidney protection and quality of life.
Can PUV be detected before birth?
Yes — antenatal ultrasound may show bilateral hydronephrosis, a distended bladder and a thickened bladder wall suggesting possible PUV. Antenatal detection allows early postnatal assessment and timely intervention.
Is valve ablation safe for newborns?
Endoscopic valve ablation is commonly performed and is the preferred definitive treatment once the child is stable. In very small or unstable neonates, temporary diversion may be safer until the infant can tolerate endoscopy under anaesthesia.
Will kidney function always recover after treatment?
Recovery depends on the degree and duration of obstruction before treatment. Early decompression improves chances of stabilising or improving renal function, but if significant scarring has already occurred, some impairment may persist and require long-term monitoring.
What long-term problems should I watch for?
Parents should watch for recurrent fevers/UTIs, poor urine stream, daytime/nighttime incontinence after the expected age, poor growth, or high blood pressure. Regular follow-up visits and investigations as advised are crucial.
Is surgical reconstruction ever needed?
Most patients are managed with valve ablation ± diversion and conservative bladder care. Reconstructive procedures (e.g., augmentation cystoplasty) are rarely needed but may be considered in selected children with severely dysfunctional bladders not responding to conservative measures.
When should we see a specialist?
Seek specialist paediatric urology care if antenatal scans suggest hydronephrosis, if a newborn has low urine output or bladder distension, or if a child has recurrent febrile UTIs, poor growth or abnormal urinary function. Early specialist input improves outcomes.