Posterior Urethral Valves (PUV)

Key Points

  • Posterior urethral valves occur exclusively in boys, and are the commonest cause of congenital bladder outlet obstruction. 
  • Current data on incidence, presentation and management of PUV in the UK is largely incomplete.
  • This study will be the first national, population-based study with prospective follow-up of a cohort of infants with PUV.

Surveillance Period

1st October 2014 – 30th September 2015

Background

Posterior urethral valves occur exclusively in boys, and are the commonest cause of congenital bladder outlet obstruction (BOO).  There is a spectrum of severity of this condition from boys that present during fetal life and may die in utero to boys who present later in life.  This condition can be detected antenatally, but does not always present this way.  It is the single commonest cause of end stage renal failure (ESRF) in children1; of boys born with PUV, up to a quarter progress to ESRF in childhood2.  Long-term outcomes for PUV are poorly documented3

Aim

The aim of this study is to describe a cohort of live-born infants with posterior urethral valves and the surgical procedures they undergo up to the age of one year, with the aim of providing information to aid counselling, service planning and further research.

Research Questions

  • What is the incidence and what are the outcomes of the condition for babies?
  • What is the risk of UTI, renal failure and mortality in the first year of life?
  • What proportion of boys have an antenatal abnormality (which may or may not be diagnostic of PUV)?  How accurate is the antenatal diagnosis in those with a diagnosed antenatal abnormality?
  • When do boys typically present?  What proportion present late?
  • Are any factors (eg. Gestation, birthweight, type of anomaly, condition of infant at diagnosis, timing of diagnosis) associated with a poor outcome (death, severe additional morbidity) for infants?
  • How is the condition managed in the UK?  Does circumcision reduce the risk of UTI, taking into account known prognostic factors?

Case Definition

All children in the UK with either an antenatal diagnosis of possible PUV or newly-diagnosed PUV confirmed on imaging or cystoscopy, presenting during the study period, irrespective of age at presentation.

Ethics Approval

The study has been approved by the NRES Committee South Central-Oxford A (Ref: 12/SC/0416)

Study Clinical Lead

Professor Liam McCarthy, Birmingham Children’s Hospital

References

  1. Woolf AS, Thiruchelvam N.  Congenital obstructive uropathy: Its origin and contribution to end-stage renal disease in children.  Adv Ren Replace Ther. 2001;8(3):157.
  2. Parkhouse HF, Barratt TM, Dillon MJ, Duffy PG, Fay J, Ransley PG, et al.  Long-term outcome of boys with posterior urethral valves.  BrJUrol.  1988;62(1):59.
  3. Holmdahl G, Sillen U.  Boys with posterior urethral valves: outcome concerning renal function, bladder function and paternity at ages 31 to 44 years.  JUrol.  2005;174(3):1031-4; discussion 1034.

Download the Data Collection Form (DCF)

BAPS-CASS Posterior Urethral Valves DCF

PLEASE NOTE: The data collection form is for your information only. Please DO NOT use it to report a case or to provide us with information on a case you have reported. If you have reported a case to us, a form with the BAPS-CASS Case ID written on it will be sent to you. If you wish to report a case, or require an additional form please contact us. Thank you.