Posterior Urethral Valves (PUV)

Michael P. D'Alessandro, M.D.
Peer Review Status: Internally Peer Reviewed

Etiology/Pathophysiology:
A congenital malformation of the male urethra that results from the anterior fusion of the normal plicae collicularis which extend distally from the verumontanum to the posterior urethral wall, forming circumferentially obstructing valves below the verumontanum. This obstruction leads to vesicoureteral reflux which can lead to renal dysplasia. The reflux can also lead to a calyceal leak of urine which can cause a perinephric urinoma or a urinary ascites.

Pathology:
Not applicable

Imaging Findings:
On VCUG see a sharply defined lucent defect in the prostatic urethra lumen distal to the verumontanum causing a fusiform dilation of the posterior urethra. A diminished urinary stream is often seen. The bladder wall is often thickened and trabeculated. Vesicoureteral reflux is present in 35-40% of patients.

US and IVP will show bilateral hydroureteronephrosis.

DDX:

• Prune belly syndrome

References:
See References Chapter.

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