What are posterior urethral valves?
Posterior urethral valves (PUV) are thin flaps of tissue in the posterior urethra, the part of the urine passage just below the bladder. They form before birth and occur only in boys. Urine pushes the flaps together, so they act like a one-way door against the flow.
To push urine past them, the bladder works harder and its wall becomes thick. Pressure can build up back into the ureters (the tubes from the kidneys) and the kidneys. How severe this is varies a great deal from one boy to another. PUV is not caused by anything the mother did during pregnancy.
Who should be checked for PUV: signs before and after birth
On a pregnancy scan, PUV may be suspected when a baby boy has both kidneys swollen, wide ureters, a large thick-walled bladder and a widened bladder outlet. In severe cases the fluid around the baby is low, which can affect lung growth. A baby boy with both kidneys swollen on the pregnancy scan should have an ultrasound within the first days after birth.
After birth, signs include:
- A weak or dribbling stream, or straining to pass urine
- A swollen bladder that can be felt in the tummy
- A urine infection with fever
- Poor feeding, vomiting or slow weight gain
Some boys with milder valves are found later, with daytime wetting, a weak stream or urine infections. Not every swollen kidney is PUV: a blockage where the kidney meets the ureter is another common cause (see PUJ obstruction).
Tests that confirm PUV: ultrasound, MCU and kidney blood tests
- Ultrasound of the kidneys and bladder.
- MCU (micturating cystourethrogram): dye is put into the bladder through a fine catheter and X-rays are taken while the baby passes urine. It shows the widened urethra above the valves and any reflux of urine up to the kidneys. This is the test that confirms PUV.
- Blood tests for creatinine (a measure of kidney function) and body salts. In the first days, a baby’s creatinine partly reflects the mother’s, so it is repeated.
- Urine culture if there is any sign of infection.
- A kidney scan (DMSA) later, to show how much each kidney is working.
First step: draining the bladder with a catheter
A fine, soft catheter is passed into the bladder to drain urine. This relieves the pressure on the kidneys straight away. Antibiotics are given if there is infection, and fluids and body salts are corrected.
Once the blockage is relieved, some babies pass very large amounts of urine for a few days. Fluids are watched closely, and a newborn may need care in a neonatal unit during this time. When the baby is stable, the valves are treated.
If a baby is too small for the telescope or too unwell, a vesicostomy may be made: a small opening of the bladder on the lower tummy that drains into the nappy. It is a temporary step and is closed later, when the valves are treated.
How valve fulguration (cystoscopic valve ablation) is done
- Your son is under general anaesthesia.
- A child-sized cystoscope (a thin telescope) is passed through the urethra.
- The valves are seen directly and cut at set points with a fine electrode (fulguration) or a small cold hook, so they no longer block the flow.
- The bladder is inspected and a catheter is left in for a short time.
The procedure usually takes 20-45 minutes and leaves no cut on the skin. It is done at ManglamPlus Medicity with a paediatric cystoscope, fine electrodes and soft catheters.
A few weeks to months later, a check MCU or cystoscopy is often done to make sure no valve tissue remains. A small remaining flap is treated the same way.
Hospital stay and recovery after valve ablation
| When | What usually happens |
|---|---|
| Before ablation | Catheter drainage; kidney tests and salts monitored |
| Day of procedure | Feeding once awake; catheter in place |
| Days 1-3 | Catheter removed; the stream is watched; home when feeding and passing urine well |
| Weeks 4-12 | Ultrasound, kidney blood tests, and a check MCU or cystoscopy |
| Early years | Regular visits, more often in the first year |
At home: watch for a good stream and regular wet nappies, keep up feeds, and give any medicines exactly as prescribed.
Call the clinic or go to hospital if: your son has a fever, is not passing urine or has few wet nappies, is feeding poorly or vomiting, or seems unusually drowsy.
Risks of treatment and problems that can appear later
Valve ablation is a short procedure. Possible problems include bleeding, urine infection, a remaining piece of valve that needs a second look, and, rarely, narrowing of the urethra from the instruments.
The larger concern is the effect the valves had before birth:
- Valve bladder: the bladder may stay thick, hold urine at high pressure or not empty fully, which can harm the kidneys over time.
- Wetting by day in older boys.
- Vesicoureteral reflux (urine flowing back to the kidneys), which often improves after the valves are removed. See VUR treatment.
- Reduced kidney function: some boys develop chronic kidney disease, and a few need dialysis or a transplant in childhood or adult life.
Lifelong follow-up of the bladder and kidneys, with paediatric nephrologists
Removing the valves is the start of care, not the end. Checks continue through childhood, puberty and into adult life:
- Ultrasound of the kidneys and bladder
- Kidney blood tests, blood pressure, urine protein and growth
- A urodynamic study when needed, to measure bladder pressure and emptying (see what to expect at a urodynamic test)
Bladder care may include passing urine by the clock, passing urine twice in a row, treating constipation, medicines to relax the bladder, and in some boys clean intermittent catheterisation (passing a fine tube to empty the bladder).
Care is shared with a paediatric nephrologist (a children’s kidney specialist), who looks after kidney function, salts, growth and blood pressure, and plans for dialysis or transplant if ever needed. The guide on urologists and nephrologists explains the two roles. You can see other children’s conditions on the pediatric urology page.
Cost of posterior urethral valves treatment in Jaipur
The clinic gives you a written estimate after the consultation and any scans, because the final bill depends on your own case. What changes the cost:
- The baby’s condition at birth and whether neonatal unit care is needed
- Whether a vesicostomy is needed before valve ablation
- Tests such as MCU, kidney blood tests and DMSA scan
- Check cystoscopy or a second ablation if valve tissue remains
- Long-term follow-up tests, including urodynamics
Insurance and government schemes
Most health insurance policies cover planned surgery of this kind, subject to their terms, such as waiting periods and room-rent limits. Whether you can go cashless depends on the hospital’s agreement with your insurer or TPA. Empanelment for government schemes such as RGHS, MAA Yojana, PM-JAY and CGHS belongs to the hospital, not the doctor, so please confirm your scheme with the ManglamPlus Medicity billing desk before admission.
Why Dr. Nitin Negi
Posterior urethral valves treatment with Dr. Nitin Negi, urologist in Jaipur
- MCh super-specialistMBBS, MS (Surgery), MCh in Genitourinary Surgery; senior residency at AIIMS, New Delhi.
- 12+ years in urologyEndourology including RIRS, Mini-PERC, PCNL, HoLEP, TURiS and TURP; laser surgery since 2016.
- 150W Holmium laserAvailable at ManglamPlus Medicity for kidney stone and prostate surgery.
- Clear explanationsEvery option, risk and cost discussed before treatment; two Jaipur locations.
Frequently asked questions
Can posterior urethral valves be treated before birth?
In a small number of severe cases, treatment before birth is done in a few specialised fetal medicine centres, and its benefit is still uncertain. For most boys, treatment starts soon after birth.
Will my son’s kidneys be normal after the valves are removed?
It depends mainly on how much the kidneys were affected before birth. Many boys keep good kidney function, while some develop kidney problems over the years. Regular checks help find changes early.
Is valve ablation a big operation?
No. It is a short telescope procedure through the urine passage, with no cut on the skin. The baby usually goes home within a few days of it.
Will he need more than one procedure?
Some boys need a check cystoscopy or a second ablation if a piece of valve remains. A few need other operations later for the bladder or reflux.
Why does my son need to see a kidney specialist as well?
Valves can affect kidney function over many years. A paediatric nephrologist manages kidney function, salts, blood pressure and growth, while the urologist looks after the bladder and urethra.
Is PUV treatment covered by insurance or schemes?
It depends on the policy and the hospital’s empanelment; newborn cover varies between policies. Please confirm with the ManglamPlus Medicity billing desk and see payment, insurance and schemes.
This page is general information, not a diagnosis or a promise of any result. Please read our medical disclaimer.