eMedicine Specialties > Radiology > Pediatrics

Posterior Urethral Valve: Multimedia

Author: John S Wiener, MD, FACS, FAAP, Clinical Assistant Professor, Division of Urology, University of North Carolina at Chapel Hill; Associate Professor of Surgery and Associate Residency Program Director, Division of Urologic Surgery, Associate Professor of Pediatrics, Duke University School of Medicine
Coauthor(s): Anamaria Gaca, MD, Clinical Instructor, Division of Pediatric Radiology, Duke University Medical Center; Jeffrey Sekula, MD, Staff Physician, Chief Resident in Urology, Department of Urology, Duke University Medical Center
Contributor Information and Disclosures

Updated: Aug 7, 2007

Multimedia

(Enlarge Image)

Media file 1: Anteroposterior view of the abdomen during a voiding cystourethrographic study. This image demonstrates a dilated bladder with trabeculation, diverticula, and bilateral massive reflux.

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Anteroposterior view of the abdomen during a voiding cystourethrographic study. This image demonstrates a dilated bladder with trabeculation, diverticula, and bilateral massive reflux.

(Enlarge Image)

Media file 2: Anteroposterior view of the abdomen during a voiding cystourethrographic study. This image demonstrates bilateral grade 4 vesicoureteral reflux. No intrarenal reflux is noted.

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Anteroposterior view of the abdomen during a voiding cystourethrographic study. This image demonstrates bilateral grade 4 vesicoureteral reflux. No intrarenal reflux is noted.

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Media file 3: Sagittal voiding image of the bladder and urethra that was obtained from a voiding cystourethrographic study before catheter removal. This image demonstrates a trabeculated, hypertrophied bladder. The bladder neck is hypertrophied and well demarcated between the body of the bladder and the dilated posterior urethra, the latter of which has the classic spinnaker-sail appearance.

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Sagittal voiding image of the bladder and urethra that was obtained from a voiding cystourethrographic study before catheter removal. This image demonstrates a trabeculated, hypertrophied bladder. The bladder neck is hypertrophied and well demarcated between the body of the bladder and the dilated posterior urethra, the latter of which has the classic spinnaker-sail appearance.

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Media file 4: Late anteroposterior image from a voiding cystourethrographic study. This image demonstrates a small, trabeculated bladder with bilateral diverticula. The posterior urethra is dilated.

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Late anteroposterior image from a voiding cystourethrographic study. This image demonstrates a small, trabeculated bladder with bilateral diverticula. The posterior urethra is dilated.

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Media file 5: Lateral view of a voiding cystourethrographic study during voiding after catheter removal. The dilated posterior urethra is highly suggestive of a posterior urethral valve, which is seen as the nonopacified line that separates the dilated posterior urethra from the normal-caliber distal urethra. The absence of the urethral catheter may be critical to demonstrate the valve, as good urethral distention is mandatory.

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Lateral view of a voiding cystourethrographic study during voiding after catheter removal. The dilated posterior urethra is highly suggestive of a posterior urethral valve, which is seen as the nonopacified line that separates the dilated posterior urethra from the normal-caliber distal urethra. The absence of the urethral catheter may be critical to demonstrate the valve, as good urethral distention is mandatory.

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Media file 6: Longitudinal sonogram of the right kidney in a 1-day-old male infant (same patient as in Images 7-10). This image demonstrates grade 4 hydronephrosis, with thinning of the renal parenchyma.

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Longitudinal sonogram of the right kidney in a 1-day-old male infant (same patient as in Images 7-10). This image demonstrates grade 4 hydronephrosis, with thinning of the renal parenchyma.

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Media file 7: Longitudinal sonogram of the right kidney (same patient as in Images 6, 8-10). This image shows that the hypoechoic areas interconnect, a finding that is consistent with hydronephrosis rather than multiple distinct renal cysts, which do not interconnect.

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Longitudinal sonogram of the right kidney (same patient as in Images 6, 8-10). This image shows that the hypoechoic areas interconnect, a finding that is consistent with hydronephrosis rather than multiple distinct renal cysts, which do not interconnect.

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Media file 8: Renal sonogram (same patient as in Images 6-7, 9-10). This image shows grade 4 hydronephrosis of the left kidney.

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Renal sonogram (same patient as in Images 6-7, 9-10). This image shows grade 4 hydronephrosis of the left kidney.

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Media file 9: Renal sonogram (same patient as in Images 6-8, 10). This image shows grade 4 hydronephrosis of the left kidney.

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Renal sonogram (same patient as in Images 6-8, 10). This image shows grade 4 hydronephrosis of the left kidney.

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Media file 10: Renal sonogram (in the same patient as in Images 6-9). This image shows grade 4 hydronephrosis of the left kidney.

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Renal sonogram (in the same patient as in Images 6-9). This image shows grade 4 hydronephrosis of the left kidney.

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Media file 11: Longitudinal sonogram of the bladder. This image demonstrates a distended bladder, with the classic keyhole appearance of the posterior urethra seen distally (on the right).

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Longitudinal sonogram of the bladder. This image demonstrates a distended bladder, with the classic keyhole appearance of the posterior urethra seen distally (on the right).

(Enlarge Image)

Media file 12: Prenatal longitudinal sonogram of the right kidney. This image demonstrates significant hydronephrosis with possible renal cortical thinning. The kidney is larger than expected for the patient's gestational age.

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Prenatal longitudinal sonogram of the right kidney. This image demonstrates significant hydronephrosis with possible renal cortical thinning. The kidney is larger than expected for the patient's gestational age.

(Enlarge Image)

Media file 13: Prenatal longitudinal sonogram of the left kidney. This image demonstrates significant hydronephrosis with possible renal cortical thinning. As is the case with the right kidney, the left kidney is longer than expected for the patient's gestational age (same patient as in Image 12).

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Prenatal longitudinal sonogram of the left kidney. This image demonstrates significant hydronephrosis with possible renal cortical thinning. As is the case with the right kidney, the left kidney is longer than expected for the patient's gestational age (same patient as in Image 12).

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Media file 14: Prenatal axial sonogram of the abdomen. This image demonstrates bilateral hydronephrosis. (The spine is the echogenic ring near the top of the image.)

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Prenatal axial sonogram of the abdomen. This image demonstrates bilateral hydronephrosis. (The spine is the echogenic ring near the top of the image.)

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Media file 15: Prenatal sonogram almost in the coronal plane. A distended urinary bladder is depicted throughout this image as well as previous prenatal ultrasonographic studies. The bladder wall may be thickened (see Image 16).

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Prenatal sonogram almost in the coronal plane. A distended urinary bladder is depicted throughout this image as well as previous prenatal ultrasonographic studies. The bladder wall may be thickened (see Image 16).

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Media file 16: Prenatal sonogram almost in the coronal plane (same patient as in Image 15). A distended urinary bladder is depicted throughout this image as well as previous prenatal ultrasonographic studies. The bladder wall may be thickened.

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Prenatal sonogram almost in the coronal plane (same patient as in Image 15). A distended urinary bladder is depicted throughout this image as well as previous prenatal ultrasonographic studies. The bladder wall may be thickened.

(Enlarge Image)

Media file 17: An initial prenatal sonogram. This image demonstrates a distended urinary bladder and oligohydramnios.

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An initial prenatal sonogram. This image demonstrates a distended urinary bladder and oligohydramnios.

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Media file 18: A first prenatal sonogram. This image demonstrates a cystic area in the region of the left renal fossa. This cystic area appears to be separate from the left kidney, which is located just to the left of the fluid collection on the image. The fluid collection was thought to represent a urinoma.

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A first prenatal sonogram. This image demonstrates a cystic area in the region of the left renal fossa. This cystic area appears to be separate from the left kidney, which is located just to the left of the fluid collection on the image. The fluid collection was thought to represent a urinoma.

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Media file 19: Sonogram. This image demonstrates mild pelvocaliectasis that involves the right kidney (same patient as in Images 20-24).

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Sonogram. This image demonstrates mild pelvocaliectasis that involves the right kidney (same patient as in Images 20-24).

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Media file 20: A second prenatal sonogram (same patient as in Images 19 and 21-24). This image demonstrates interval resolution of the fluid collection in the left renal fossa and a left kidney with pelvocaliectasis.

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A second prenatal sonogram (same patient as in Images 19 and 21-24). This image demonstrates interval resolution of the fluid collection in the left renal fossa and a left kidney with pelvocaliectasis.

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Media file 21: A second prenatal sonogram (same patient as in Images 19-20, 22-24). This image also demonstrates pelvocaliectasis that involves the right kidney.

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A second prenatal sonogram (same patient as in Images 19-20, 22-24). This image also demonstrates pelvocaliectasis that involves the right kidney.

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Media file 22: A second prenatal sonogram, transverse view (same patient as in Images 19-21, 23-24). This image of the abdomen demonstrates bilateral pelvocaliectasis.

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A second prenatal sonogram, transverse view (same patient as in Images 19-21, 23-24). This image of the abdomen demonstrates bilateral pelvocaliectasis.

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Media file 23: Postnatal sonogram on the first day of life (same patient as in Images 19-22, 24). This sagittal image of the bladder demonstrates bladder wall thickening and prominence of the distal left ureter.

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Postnatal sonogram on the first day of life (same patient as in Images 19-22, 24). This sagittal image of the bladder demonstrates bladder wall thickening and prominence of the distal left ureter.

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Media file 24: Transverse sonogram of the bladder (same patient as in Images 19-23). Bladder wall thickening is again demonstrated.

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Transverse sonogram of the bladder (same patient as in Images 19-23). Bladder wall thickening is again demonstrated.

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Media file 25: Excretory images obtained from renal scanning that was performed with diethylenetriaminepentaacetic acid. This study demonstrates radiotracer accumulation within the dilated renal collecting systems and dilated ureters. The bladder remains empty because of catheter drainage.

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Excretory images obtained from renal scanning that was performed with diethylenetriaminepentaacetic acid. This study demonstrates radiotracer accumulation within the dilated renal collecting systems and dilated ureters. The bladder remains empty because of catheter drainage.

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Media file 26: Renal scanning images performed with diethylenetriaminepentaacetic acid. This study demonstrates accumulation of radiotracer within the renal collecting systems bilaterally; within the dilated ureters bilaterally; and within a small, irregular-appearing bladder. Renograms (top right and bottom left) demonstrate poor clearance of contrast material from the renal collecting systems. The relatively poorer function in the left kidney reflects congenital renal dysplasia.

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Renal scanning images performed with diethylenetriaminepentaacetic acid. This study demonstrates accumulation of radiotracer within the renal collecting systems bilaterally; within the dilated ureters bilaterally; and within a small, irregular-appearing bladder. Renograms (top right and bottom left) demonstrate poor clearance of contrast material from the renal collecting systems. The relatively poorer function in the left kidney reflects congenital renal dysplasia.

References

Young HH, Frontz WA, Baldwin JC. Congenital obstruction of the posterior urethra. J Urol, 3: 289-365, 1919. J Urol. Jan 2002;167(1):265-7; discussion 268. [Medline].
Imaji R, Dewan PA. The clinical and radiological findings in boys with endoscopically severe congenital posterior urethral obstruction. BJU Int. Aug 2001;88(3):263-7. [Medline]. [Full Text].
Williams CR, Pérez LM, Joseph DB. Accuracy of renal-bladder ultrasonography as a screening method to suggest posterior urethral valves. J Urol. Jun 2001;165(6 pt 2):2245-7. [Medline].
Bani Hani O, Prelog K, Smith GH. A method to assess posterior urethral valve ablation. J Urol. Jul 2006;176(1):303-5. [Medline].
Glassberg KI, Horowitz M. Urethral valve and other anomalies of the male urethra. In: Belman AB, King LR, Kramer SA, eds. Clinical Pediatric Urology. 4^th ed. London, UK: Martin Dunitz Ltd; 2002:899-946.
Krishnan A, de Souza A, Konijeti R, Baskin LS. The anatomy and embryology of posterior urethral valves. J Urol. Apr 2006;175(4):1214-20. [Medline].
Salam MA. Posterior urethral valve: outcome of antenatal intervention. Int J Urol. Oct 2006;13(10):1317-22. [Medline].

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Keywords

PUV, bladder outlet obstruction, posterior urethra, congenital obstructing posterior urethral membrane, COPUM, voiding dysfunction

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Contributor Information and Disclosures

Author

John S Wiener, MD, FACS, FAAP, Clinical Assistant Professor, Division of Urology, University of North Carolina at Chapel Hill; Associate Professor of Surgery and Associate Residency Program Director, Division of Urologic Surgery, Associate Professor of Pediatrics, Duke University School of Medicine
John S Wiener, MD, FACS, FAAP is a member of the following medical societies: Alpha Omega Alpha, American Academy of Pediatrics, American College of Surgeons, American Medical Association, American Urological Association, Society for Fetal Urology, Society for Pediatric Urology, and Society of University Urologists
Disclosure: Nothing to disclose.

Coauthor(s)

Anamaria Gaca, MD, Clinical Instructor, Division of Pediatric Radiology, Duke University Medical Center
Disclosure: Nothing to disclose.

Jeffrey Sekula, MD, Staff Physician, Chief Resident in Urology, Department of Urology, Duke University Medical Center
Disclosure: Nothing to disclose.

Medical Editor

Lori Lee Barr, MD, FACR, FAIUM, Clinical Associate Professor of Radiology, University of Texas Health Science Center in San Antonio; Clinical Assistant Professor of Radiology, University of Texas Medical Branch at Galveston; Member, Board of Directors, Austin Radiological Association; Consulting Staff, Seton Health Network, Columbia/St David's Healthcare System, Healthsouth Rehabilitation Hospital of Austin, Georgetown Hospital, St Mark's Medical Center, Cedar Park Regional Medical Center
Lori Lee Barr, MD, FACR, FAIUM is a member of the following medical societies: American Association for Women Radiologists, American College of Radiology, American Institute of Ultrasound in Medicine, American Roentgen Ray Society, American Society of Pediatric Neuroradiology, Association of University Radiologists, Radiological Society of North America, Society for Pediatric Radiology, Society of Radiologists in Ultrasound, Southern Medical Association, Texas Radiological Society, and Undersea and Hyperbaric Medical Society
Disclosure: Nothing to disclose.

Pharmacy Editor

Bernard D Coombs, MB, ChB, PhD, Consulting Staff, Department of Specialist Rehabilitation Services, Hutt Valley District Health Board, New Zealand
Disclosure: Nothing to disclose.

Managing Editor

Kieran McHugh, MBBCh, Honorary Lecturer, The Institute of Child Health; Consultant Pediatric Radiologist, Department of Radiology, Great Ormond Street Hospital for Children, London, UK
Kieran McHugh, MBBCh is a member of the following medical societies: American Roentgen Ray Society and Royal College of Radiologists
Disclosure: Nothing to disclose.

CME Editor

Robert M Krasny, MD, Consulting Staff, Department of Radiology, The Angeles Clinic and Research Institute
Robert M Krasny, MD is a member of the following medical societies: American Roentgen Ray Society and Radiological Society of North America
Disclosure: Nothing to disclose.

Chief Editor

Eugene C Lin, MD, Consulting Radiologist, Virginia Mason Medical Center; Clinical Assistant Professor of Radiology, University of Washington School of Medicine
Eugene C Lin, MD is a member of the following medical societies: American College of Nuclear Medicine, American College of Radiology, Radiological Society of North America, and Society of Nuclear Medicine
Disclosure: Nothing to disclose.

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eMedicine Specialties > Radiology > Pediatrics

Posterior Urethral Valve: Multimedia

Multimedia

Anteroposterior view of the abdomen during a voiding cystourethrographic study. This image demonstrates a dilated bladder with trabeculation, diverticula, and bilateral massive reflux.

Anteroposterior view of the abdomen during a voiding cystourethrographic study. This image demonstrates bilateral grade 4 vesicoureteral reflux. No intrarenal reflux is noted.

Late anteroposterior image from a voiding cystourethrographic study. This image demonstrates a small, trabeculated bladder with bilateral diverticula. The posterior urethra is dilated.

Longitudinal sonogram of the right kidney in a 1-day-old male infant (same patient as in Images 7-10). This image demonstrates grade 4 hydronephrosis, with thinning of the renal parenchyma.

Longitudinal sonogram of the right kidney (same patient as in Images 6, 8-10). This image shows that the hypoechoic areas interconnect, a finding that is consistent with hydronephrosis rather than multiple distinct renal cysts, which do not interconnect.

Renal sonogram (same patient as in Images 6-7, 9-10). This image shows grade 4 hydronephrosis of the left kidney.

Renal sonogram (same patient as in Images 6-8, 10). This image shows grade 4 hydronephrosis of the left kidney.

Renal sonogram (in the same patient as in Images 6-9). This image shows grade 4 hydronephrosis of the left kidney.

Longitudinal sonogram of the bladder. This image demonstrates a distended bladder, with the classic keyhole appearance of the posterior urethra seen distally (on the right).

Prenatal longitudinal sonogram of the right kidney. This image demonstrates significant hydronephrosis with possible renal cortical thinning. The kidney is larger than expected for the patient's gestational age.

Prenatal longitudinal sonogram of the left kidney. This image demonstrates significant hydronephrosis with possible renal cortical thinning. As is the case with the right kidney, the left kidney is longer than expected for the patient's gestational age (same patient as in Image 12).

Prenatal axial sonogram of the abdomen. This image demonstrates bilateral hydronephrosis. (The spine is the echogenic ring near the top of the image.)

Prenatal sonogram almost in the coronal plane. A distended urinary bladder is depicted throughout this image as well as previous prenatal ultrasonographic studies. The bladder wall may be thickened (see Image 16).

Prenatal sonogram almost in the coronal plane (same patient as in Image 15). A distended urinary bladder is depicted throughout this image as well as previous prenatal ultrasonographic studies. The bladder wall may be thickened.

An initial prenatal sonogram. This image demonstrates a distended urinary bladder and oligohydramnios.

A first prenatal sonogram. This image demonstrates a cystic area in the region of the left renal fossa. This cystic area appears to be separate from the left kidney, which is located just to the left of the fluid collection on the image. The fluid collection was thought to represent a urinoma.

Sonogram. This image demonstrates mild pelvocaliectasis that involves the right kidney (same patient as in Images 20-24).

A second prenatal sonogram (same patient as in Images 19 and 21-24). This image demonstrates interval resolution of the fluid collection in the left renal fossa and a left kidney with pelvocaliectasis.

A second prenatal sonogram (same patient as in Images 19-20, 22-24). This image also demonstrates pelvocaliectasis that involves the right kidney.

A second prenatal sonogram, transverse view (same patient as in Images 19-21, 23-24). This image of the abdomen demonstrates bilateral pelvocaliectasis.

Postnatal sonogram on the first day of life (same patient as in Images 19-22, 24). This sagittal image of the bladder demonstrates bladder wall thickening and prominence of the distal left ureter.

Transverse sonogram of the bladder (same patient as in Images 19-23). Bladder wall thickening is again demonstrated.

Excretory images obtained from renal scanning that was performed with diethylenetriaminepentaacetic acid. This study demonstrates radiotracer accumulation within the dilated renal collecting systems and dilated ureters. The bladder remains empty because of catheter drainage.

More on Posterior Urethral Valve

References

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Keywords

Contributor Information and Disclosures

Author

Coauthor(s)

Medical Editor

Pharmacy Editor

Managing Editor

CME Editor

Chief Editor