What are posterior urethral valves?

Posterior urethral valves, or PUV, is a congenital (from birth) condition that happens only in boys. The condition happens when the urethra, which is the tube that connects the bladder to the outside of the body, has excess flaps of tissue in it.

Liquid waste is processed in the kidneys and then flows through a tube called the ureter and into the bladder. The bladder holds urine until a boy is ready to go to the bathroom. When the boy urinates, the urine passes from the bladder through a tube in the penis called the urethra, which leads to the outside of the body. When a child has PUV, the excess tissue flaps in the urethra cause the urine to back up or even to reverse back through the urethra, bladder, ureter, and kidneys. This is called vesicoureteral reflux (PDF). These organs swell with urine, which causes damage to tissues and cells.

What are symptoms of PUV?

Symptoms include:

  • An enlarged bladder
  • A urinary tract infection
  • Painful urination
  • Difficulties with toilet training or problems with wetting after the boy has been toilet-trained
  • Frequent need to urinate
  • A weak stream of urine
  • Poor weight gain

How is it diagnosed?

Sometimes PUV is mild and isn't discovered until a child is older. Other times it's severe and causes many symptoms. In serious cases, the condition may be discovered during prenatal visits before a child is born, or during a newborn examination just after a child is born.

Several tests may be performed to confirm the presence of PUV and help physicians get a better understanding of your child's unique case. Those tests may include:

How is it treated?

A surgery called a valve ablation is the most common treatment for PUV. Valve ablation is a minimally invasive surgery which involves inserting a tiny telescope into the urethra. Physicians use the telescope tube to remove the excess tissue.

In some cases, a different procedure called urinary diversion may be necessary. This may involve creating a temporary opening in the abdomen where urine can exit the body.

Your child will need to continue to see the physician after surgery. Sometimes boys continue to experience mild symptoms of PUV, such as incontinence, vesicoureteral reflux (PDF), a frequent or urgent need to urinate, and/or kidney damage. Often, medications will be prescribed after surgery. Rarely, a follow-up surgery is necessary.

About surgery for posterior urethral valves at Children's

The pediatric urology surgery team at Children's provides next-generation care to neonatal infants, newborns, children, and adolescents from throughout the Upper Midwest. The team consistently performs some of the most cutting-edge surgical procedures available, including newborn surgery, minimally invasive surgery, and robotic surgery, when appropriate. Urologic surgery is performed at Children's - Minneapolis, Children's - St. Paul and Children's West.

  • If you are a family member looking for a Children's specialist in urology surgery, please call the Center for Pediatric Urology at 1-800-992-6983.
  • If you are a health professional looking for a consultation or referral information, please call Children's Physician Access at 1-866-755-2121 (toll-free).

Return to Children's pediatric urology surgery home page.