Posterior-Urethral-Valves-PUV-An-Overview (1).pptx

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1. PoSterior Urethral ValveS (PUV): An Overview Posterior urethral valves (PUV) are congenital obstructive lesions. They affect the male urethra, occurring in 1 in 8,000 male births. PUV is a significant cause of chronic kidney disease in children. Presentation ranges from prenatal hydronephrosis to postnatal urinary retention.

2. Embryology and PathogeneSiS of PUV Etiology TheorieS Abnormal insertion of the mesonephric duct is one theory. Another is persistent urogenital membrane. TypeS of PUV Type I is most common (95%). Type II is rare. Type III is less common, often a congenital urethral membrane.

3. Prenatal DiagnoSiS and Screening 1 Prenatal UltraSound Findings include bilateral hydronephrosis. Thickened bladder wall and keyhole sign are also present. 2 Amniotic Fluid Oligohydramnios indicates poorer prognosis. 3 Fetal InterventionS Vesicoamniotic shunt placement is used in severe cases, though controversial.

4. PoStnatal PreSentation of PUV 1 Neonatal Period Respiratory distress occurs due to pulmonary hypoplasia. Renal failure can also occur. 2 Infancy/Childhood UTIs, voiding dysfunction, and enuresis are common. 3 Older Children Subtle symptoms like daytime incontinence may be present.

5. DiagnoStic Evaluation for PUV VCUG Voiding cystourethrogram is the gold standard. It shows dilated posterior urethra and valve leaflets. Renal UltraSound Assesses hydronephrosis and renal changes. LabS Serum creatinine, electrolytes, and urine analysis assess renal function and rule out infection.

6. Initial Management and Stabilization 1 Catheterization Bladder drainage relieves obstruction. 2 IV AntibioticS Treat UTIs with intravenous antibiotics. 3 Monitoring Monitor fluid balance and electrolytes. Correct imbalances.

7. Surgical Management: Valve Ablation 2 3 Endoscopic valve ablation is the primary surgical treatment. Use Bugbee electrode or laser to incise leaflets. The goal is to relieve obstruction. Minimize urethral damage. Postoperative VCUG confirms ablation. EndoScopic Ablation 1 Bugbee Electrode/LaSer Relieve ObStruction

8. DiverSion and ReconStruction 1 VeSicoStomy 2 Upper Tract 3 UrethroplaSty Vesicostomy is temporary diversion in neonates with severe renal insufficiency or sepsis. Upper tract diversion is rarely indicated. Urethroplasty is for urethral strictures. Also used for diverticula.

9. Long-Term OutcomeS and FolloW- Up CKD Chronic kidney disease is a leading complication. It occurs in 20-30% of patients. Voiding DySfunction Incontinence, frequency, and urgency are common. HypertenSion Hypertension is associated with CKD. Regular monitoring of renal function is necessary. Also monitor blood pressure and voiding habits.

10. ConcluSion: Key TakeaWayS 1 Early Intervention Early diagnosis and intervention ensure best outcomes. 2 Lifelong FolloW-Up Lifelong follow-up monitors complications. 3 MultidiSciplinary Approach Urologists and nephrologists are important. Ongoing research aims to improve understanding. The goal is to improve PUV management.

11. Gufran Ali Group - 4M03 Samarkand State Medical University Pediatric Surgery Posterior urethral valves