Posterior Urethral Valves Wreck Havoc on the Urinary Tract

Our son, Brandon, was three years old when we first discovered blood in his urine. We were horrified and immediately took him to the doctor. Lab tests showed crystals and a massive amount of blood. We were referred to a urologist who scheduled our first cystoscopy. The procedure took less than ten minutes and concluded with the diagnosis that people periodically bleed for no reason and that we shouldn't be concerned over a one-time fluke. The more we argued, the more the doctor resisted. After several minutes of heated discussion, we conceded. After all, he was the doctor, so he had to be right.

Several months later, Brandon had another episode of massive blood in his urine. Fortunately, by that time a pediatric urologist had opened a practice in our town, so we made an appointment. As with the first doctor, our new physician scheduled a cystoscopy. This time the doctor emerged with a diagnosis of posterior urethral valves.

We learned posterior urethral values (or PUV) are present in approximately 2% of the male population. The valves are located in the urethra (the tube inside the penis) just outside the bladder and act like boat sails which hold back the urine. When urine can't flow through the urethra and exit the body, it refluxes back through the bladder and into the kidneys. The more the body tries to void the urine through the urinary tract, the more the kidneys and bladders well; and the tissue starts to bloat and give way. The end result is a distorted, dysfunctional urinary tract in which the kidneys can be severely damaged. The condition is present before birth. We were told Brandon's distended stomach would have been easily visible on ultrasound if we'd have one late in pregnancy. This also confirmed our suspicion that the first doctor hadn't actually performed the procedure he'd been so rude about performing.

The pediatric urologist resected the valves-meaning he clipped them close to the wall of the urethra. After surgery Brandon was able to urinate freely. Until that point we only knew Brandon was a difficult child to potty train because he continuously had accidents. We learned the accidents weren't really accidents, they were merely times when the valves relaxed and released the urine unexpectedly.

Clipping the valves allowed the urine to flow freely and theoretically corrected the problem. However, two years later Brandon was again unable to use the bathroom without extreme difficulty. Bathroom accidents became a daily occurrence, and Brandon's self esteem plummeted. There's nothing cool about being in the first grade and not being able to make it to the restroom on time.

A return visit to the pediatric urologist led to another surgery to again resect the valves. The possibility exists that the valves may need to periodically be resected as Brandon hits puberty; however, we are optimistic that posterior urethral valves will no longer wreck havoc on his urinary tract.