Posterior Urethral Valves (PUV) is a congenital condition affecting male infants in which abnormal membranous folds obstruct the posterior urethra, impairing urine flow from the bladder. PUV is one of the most serious causes of lower urinary tract obstruction in children and a significant contributor to chronic kidney disease when not detected and managed early.

The obstruction caused by posterior urethral valves leads to increased pressure within the bladder, ureters, and kidneys. This back pressure interferes with normal kidney development and function, potentially causing hydronephrosis, renal dysplasia, and progressive loss of kidney function. In severe cases, kidney damage may begin before birth.

Clinical presentation varies depending on severity. Severe cases may be detected antenatally through ultrasound showing bladder distension and hydronephrosis. Newborns may present with poor urine stream, urinary retention, respiratory distress, or failure to thrive. Milder cases may present later in childhood with recurrent urinary tract infections, poor growth, or declining kidney function.

Diagnosis involves imaging studies to assess urinary tract anatomy and obstruction. Renal ultrasound evaluates kidney structure, while additional imaging confirms the presence and severity of obstruction. Early diagnosis is critical to prevent irreversible kidney damage.

Management focuses on relieving obstruction, protecting kidney function, and managing long-term complications. Even after relief of obstruction, ongoing nephrology follow-up is essential, as many patients remain at risk for bladder dysfunction, recurrent infections, and progressive kidney disease.
With early detection and multidisciplinary care, outcomes have improved significantly. However, PUV remains a lifelong condition requiring careful monitoring to preserve kidney health and quality of life.