Is your little one having difficulty urinating? It could be due to Posterior Urethral Valves (PUV)!

As a mother or father, you worry a lot about the health of your little one, don't you? Sometimes, even the smallest illnesses that our children suffer from can be a source of great stress. Today, we are going to talk about a condition that requires some concern, but you need to understand it without panicking. This is a congenital condition that only affects boys , and it is called `Posterior Urethral Valves` or `(PUV)`.

What are Posterior Urethral Valves (PUV)?

Simply put, `Posterior Urethral Valves` are a condition where an extra piece of tissue grows inside the tube that our little boys' urine comes out of, the urethra (also called the urethra by doctors), blocking the passage of urine. Think of it like something getting stuck in the middle of a water pipe. This is a congenital disorder .

When the urethra is blocked in this way, the bladder does not empty completely. What happens then? Urine can back up into the bladder and then into the kidneys. Just like when a water pipe is blocked, it backs up and goes up. This can damage the bladder and kidneys.

Sometimes doctors detect this condition during an ultrasound scan while the baby is still in the womb. Or it can be detected after the baby is born or during infancy. It is important to remember that this condition only affects boys . In some places, it is also called Congenital Obstructive Posterior Urethral Membrane (COPUM).

Is this condition very rare?

In fact, it is reported that about 500 babies born worldwide each year are affected by this condition, ``Posterior Urethral Valves.' ' It is also the leading cause of urinary tract obstruction in boys.

What are the symptoms of this condition?

Now let's see what symptoms the child shows in this `(PUV)` condition. Sometimes when you see these, you too will realize, 'Ah, this happens to my son too, right?'

• The edge of the urine passage is very weak, or it drips: Does the edge seem very weak when the baby urinates ? Or does it drip even after the baby has finished urinating ? This is one symptom.
• Frequent urinary tract infections (UTIs): If a young child has a fever, is not drinking milk, is crying a lot, or has difficulty urinating , it may be a UTI. Children with UTIs are more likely to have these infections.
• Baby's weight is not gaining properly: If your baby is drinking enough milk but is gaining weight very slowly, you should also be concerned about that.
• Pain during urination : It is difficult and painful to urinate . The baby may even cry. Doctors call this `(Dysuria)`.
• Difficulty urinating : Does your baby seem to be straining to urinate ? OrDoes it take a long time to start urinating ?
• Oligohydramnios: Did your doctor say that the amount of amniotic fluid around your baby was low (oligohydramnios) during your pregnancy scan? That could also be related to this.
• Hydronephrosis: Doctors may also report that the kidneys appear swollen (Hydronephrosis) during a scan , either during pregnancy or after the baby is born. This means that the kidneys are not draining properly and are under pressure.

Why is this happening? What is the reason?

Okay, now you're probably wondering, 'Why did this happen to our son?' What really caused this?

These `Posterior Urethral Valves` are caused by extra tissue growing in the part of the urethra closest to the bladder during early development in the baby's womb. This extra tissue narrows the urethra, as if a tube is stuck inside. This blocks the way for urine to flow out.

However, doctors are still unable to pinpoint the exact reason why this extra tissue develops in this way. It is currently considered to be a developmental abnormality that occurs during the embryonic stage.

What other complications can this cause?

If this ``(PUV)`` condition is not treated properly and promptly, it can lead to further health problems. That is why it is very important to be aware of this quickly and follow your doctor's advice.

• Vesicoureteral reflux (VUR) : This is when urine from the bladder flows backward through the ureter into the kidneys. Imagine what happens if urine that should go down instead goes up? It can lead to kidney infections and long-term damage.
• Urinary retention: This means that not all of the urine comes out, and a little always remains inside. This can cause the bladder to enlarge and lead to infections.
• Kidney swelling: The kidneys can swell due to obstruction of the urinary system.
• Kidney failure: This is the most dangerous outcome of this condition. In the long term, the kidneys can become damaged and lose their function.

How do doctors detect this?

Now let's see how doctors accurately diagnose this ``(PUV)`` condition, that is, how to diagnose the disease.

• Ultrasound Scan during Pregnancy: Sometimes, an ultrasound scan done while you are expecting a baby can provide clues about this condition (e.g., enlarged bladder, swollen kidneys, decreased amniotic fluid around the baby).
• Tests performed after the baby is born:
• Kidney `Ultrasound Scan`:An ultrasound scan performed after the baby is born can clearly detect any changes or obstructions in the baby's kidneys, bladder, and urinary system.
• `Voiding Cystourethrogram (VCUG): This is the main test to confirm the presence of `(PUV)`. In this, a small tube (catheter) is inserted into the child's urethra and a special liquid (contrast dye) is passed through it into the bladder. Then a series of `X-ray` pictures are taken as the child urinates . This shows how the bladder fills, how it empties, where the urethra is blocked (`valves`) and whether urine is flowing backwards into the kidneys (`VUR`).
• Cystoscopy: This involves passing a small, flexible tube (a device with a camera and light attached - a cystoscope) down the urethra to look directly at the blocked valves. This allows for a closer look and sometimes treatment during the procedure.
• Kidney function tests: Blood and urine tests are done to see how well the kidneys are working.

What are the treatments for this?

Okay, now let's talk about the treatment for this. Don't be scared to hear this, because now there are good treatments for this. Doctors will give your child the best treatment possible.

The main goal of treatment is to remove the blockage in the urinary tract and allow urine to pass easily.

• `Fulguration` (Valve ablation): This is often done to remove the tissue (valves) that is causing the blockage. During a `cystoscopy`, a small instrument is passed through the `cystoscope` and, using electricity or laser light, the excess tissue is destroyed with heat. This is called `fulguration` or `valve ablation`. This is the main and first treatment.

Depending on the child's condition, the nature of the blockage, and whether there are other complications, the doctor may suggest other treatments:

• Catheterization: The temporary placement of a tube to empty the bladder. Sometimes this is done right after the baby is born to relieve pressure on the bladder and kidneys.
• Urethral dilation: In some cases, the urethra can be widened.
• Vesicostomy: Some children, especially those with severe kidney damage, may have a surgery called a vesicostomy. This involves making a small hole in the skin of the abdomen directly from the bladder, allowing urine to drain through it. This is usually temporary and will be closed later.
• Antibiotics: If you have a urinary tract infection, you will be given antibiotics. Sometimes, you may continue to take low doses of antibiotics to prevent infection.
• `Dialysis` or `Kidney transplant`:Unfortunately, some children's kidneys become so severely damaged that they fail, requiring dialysis or a kidney transplant.
• Antispasmodics: Some children may have problems with bladder function. Antispasmodics can be given to make urination easier.

Very rarely, if this condition is diagnosed while the baby is still in the womb, some specialists will attempt to perform fetal surgery, but it is very complex and rare.

What will the future hold with this situation? (Prognosis)

Okay, what happens after treatment? What will the child's future be like? This is a question that many parents have.

• Long-term monitoring: If your child has a condition called (PUV), even if they are treated, they will need to be monitored for the rest of their life to monitor their kidney function and urinary system health. This means continuing to see the doctor, have blood tests, urine tests, and ultrasound scans.
• Urinary incontinence: Some children may experience urinary incontinence, or the need to urinate frequently , either as children, teenagers, or adults.
• Risk of kidney failure: Studies suggest that about 15% of children with PUV are at risk of developing kidney failure at some point in their lives . That's why it's important to stay under medical supervision.

But don't worry. With proper treatment and good follow-up, most children can live normal, healthy lives.

When should I see a doctor?

If your little one has any of the symptoms we've discussed, such as weak urinary tract, frequent UTIs, don't waste time and see a pediatrician or pediatric surgeon right away. If left untreated, this condition can lead to serious health problems, especially kidney damage.

What are the important questions to ask the doctor?

When you see your doctor, it's important to listen to everything that's on your mind. It may be helpful to ask yourself these questions:

• What treatment options are available for my child?
• How does this treatment work? What happens as a result?
• What should we expect during treatment and recovery?
• How should I care for my child during the recovery period? What are some things I need to pay special attention to?
• When should we come see the doctor again? (Follow-up)

Mom and Dad, keep this in mind.

It's normal to feel scared, worried, and sad when you find out your baby has this condition. But please remember this:

There was nothing you could have done to prevent this situation. This is not because of your fault, something you did or said, or something you didn't do. This is something that comes with birth.

Your child's doctor and healthcare team will help and guide you every step of the way. They will explain everything to you, including what to expect, what treatment options are available, and how to care for your child. So be sure to keep your doctor's follow-up appointments. Don't be afraid or embarrassed to ask any questions you have, no matter how small. It's important to know everything clearly because you want the best for your child.

` Posterior Urethral Valves, PUV, Urinary Tract Diseases in Boys, Urinary Obstruction, Kidney Diseases, Child Health, Birth Defects