Delayed presentation of posterior urethral valves: A not so benign condition

Purpose: Posterior urethral valves are usually detected during infancy by p renatal sonography. Rarely they may be diagnosed during later childhood, ad olescence or even adulthood. Less is known about presentation and outcome i n these older patients. We reviewed our experience at 4 institutions with t he late presentation of posterior urethral valves. Materials and Methods:A. 13-year retrospective review revealed the late pre sentation of posterior urethral valves in 47 patients 5 to 35 years old (me an age 8). Data collected included presenting symptomatology, radiographic findings and renal function. Statistical analysis determined the relationsh ips among presenting symptoms, patient age at diagnosis and renal function. Results: The most common presenting symptoms were diurnal enuresis in 60% o f the cases, urinary tract infection in 40% and voiding pain in 13%. Other presenting symptoms in less than 10% of the cases included poor stream, gro ss hematuria and proteinuria. At diagnosis hydronephrosis and vesicouretera l reflux were present in 40 and 33% of the patients, respectively, while se rum creatinine was elevated in 35% and end stage renal disease had develope d in 10%. The severity of presenting signs and symptoms was significantly a ssociated with renal impairment, while patient age at diagnosis was not. Conclusions: Posterior urethral valves is not merely a disease of infancy. Voiding cystourethrography should be considered in boys older than 5 years who have voiding complaints, especially in association with diurnal enuresi s or urinary tract infection. Patients who present late with posterior uret hral valves are at risk for progression to end stage renal disease.