Posterior Urethral Valves in Fetuses

What are Posterior Urethral Valves in Fetuses?

Posterior urethral valves (PUV) is an uncommon condition that results in obstruction of the flow of urine out of the bladder into the amniotic sac in utero.

Posterior urethral valves (PUV) are pieces of tissue that block the flow of urine out of the bladder. This reduces the fluid around the baby while the bladder becomes overfull and enlarged, which can lead to kidney failure and problems with lung development.

What Causes PUV?

Experts believe that posterior urethral valves happen early in a baby's growth in the uterus. The valves occur in about 1 in 8,000 male fetuses and much less frequently in female fetuses. They are believed to happen by chance, but some cases have been seen in twins and siblings. This means a gene or family factors may also be involved in some cases.

How is PUV Diagnosed?

PUV can be found during a routine prenatal ultrasound when obstruction of the flow of urine out of the bladder into the amniotic sac in utero is seen. Evaluation of the urinary system is part of the routine ultrasound examination done by our office as part of routine prenatal care around the 20th week of pregnancy. If you have been referred to our office because your providers are concerned about the bladder, or the amniotic fluid around your baby, the urinary tract including the bladder will be one of things that we will evaluate at a visit to our office.

What Are the Effects of PUV on My Baby?

When PUV occurs, the fluid around the baby will decrease or become absent, while the bladder becomes overfull and enlarged. This can lead to poor lung development and kidney failure.

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UR Medicine's Treatments for Posterior Urethral Valves in Fetuses

How Might PUV Be Treated before Birth?

Most PUV is followed closely, and repaired after delivery. In rare cases fetuses with PUV will need to be treated before they are born. A small catheter, or shunt, can be placed in the babies bladder, draining the urine blockage. This is done through the pregnant person’s womb, and is completed under ultrasound guidance in the hospital by our advanced fetal specialists. Prior to placing this, ultrasound assessments, consultation, and possibly assessment of kidney function by vesicocentesis (removing some fluid from the fetal bladder) may be done using a small needle in a procedure similar to an amniocentesis. Our Maternal-Fetal Medicine physicians and fellows will review all the findings, and treatment options with you before any interventions.

How Will PUV Be Treated After Birth? What Will Happen to My Baby After Delivery?

Most PUV is followed closely, and repaired after delivery. Even with this care, most children with this condition will need to deliver at a tertiary center (like Strong Memorial Hospital and Golisano Children’s Hospital) to allow for evaluation and care after birth by specialists in pediatrics, surgery and pediatric urology. There may be need for surgery after birth.

Follow up through childhood will be necessary to follow kidney function as about 1 in 3 children with PUV may have on-going kidney disease. The outlook for the condition is better when it’s found and evaluated early.

At Golisano Children's Hospital, the Pediatric Urology, Pediatric Nephrology, and Transplant Surgery teams work together to help children with complex kidney disease.

The Pediatric Urology team is the largest and most experienced practice of its kind in upstate New York.

What Sets Us Apart?

Our OB/GYN MFM ultrasound unit is certified by the American Institute of Ultrasound in Medicine to perform Level II ultrasounds, a more in-depth evaluation.

Our experienced Registered Diagnostic Medical Sonographers and state-of-the-art technology such as 3D/4D capabilities help diagnose your developing baby effectively and accurately.

For fetuses with this rare condition that require intervention, our Maternal-Fetal Medicine team may discuss in-utero treatment options including bladder drainage and bladder shunting (creating a passage for fluid to flow). Our MFM physicians and fellows will review all the findings, and treatment options with you before any interventions. We are the only practice in Upstate NY offering these services. Over the past five years, UR Medicine's Maternal-Fetal Medicine has cared for and evaluated more than 500 fetuses with kidney and bladder issues diagnosed in utero.

Because many fetal health conditions can involve cardiac concerns, our office offers on-site fetal echocardiography. UR Medicine also offers the Rochester metropolitan area and surrounding region’s only fetal MRI center, to help evaluate many complex conditions and placenta abnormalities. We also have fetal assessment and monitoring on-site at both of our office locations.

When you are facing a pregnancy with a complex condition, just making all the needed appointments can be overwhelming. Our team of fetal and maternal care coordinators will ensure you receive all the information and support you need before and during delivery.

These care specialists can help with everything from: