Posterior Urethral Valves: Case History

A 10-year-old boy is brought to your clinic because he has had a life-long problem of day and night urine incontinence. He reports that he can't "pee across the bathroom like some of the other boys at school." When he feels the urge to void, he has little warning before urine starts to drain through his urethra.

An ultrasound (not shown) showed mild hydronephrosis bilaterally. This is a voiding cystourethrogram (VCUG). The bladder is the bulbous white circle (actually a sphere) at the top of the x-ray. Notice that the connection between the bladder and the urethra looks like a wide funnel. This is a dilated posterior (proximal) urethra. Notice the interruption in the contour of the urethra at the bottom of the funnel. These are posterior urethral valves, flaps of tissue that obstruct urine flow.

The obstruction has caused his bladder to work harder to empty. This has resulted in hypertorphy of the bladder muscle and at least one diverticulum (bulge on the bladder in the upper right-hand side).

The valves were resected through a small telescope placed through the penis into the urethra. The photo on the right shows that the posterior urethral valves had formed as a diaphragm obstructing the urethra. The urethral lumen should be almost as wide as the picture. The opening through the valves is too small to allow the cystoscope to pass.

After the valves were resected, the urethra and bladder drained normally. The boy still had some incontinence (from the bladder muscle hypertrophy and irritability), but it was much improved.

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©David A. Hatch, M.D., 1996