Late presentation of posterior urethral valves

Area of Science:

• Urology
• Pediatric Urology
• Adult Urology

Background:

• Posterior urethral valves (PUV) are the most common congenital cause of bladder outlet obstruction in male neonates.
• While typically diagnosed in infancy, a subset of patients (10%) present later in life with obstructive lower urinary tract symptoms.

Observation:

• A case of an adult male presenting with obstructive lower urinary tract symptoms, hematuria, and elevated serum creatinine is described.
• Initial evaluation with voiding cystourethrogram (VCUG) was inconclusive due to urethral narrowing.
• Diagnosis was confirmed via rigid urethrocystoscopy, revealing a type-I posterior urethral valve.

Findings:

• The adult patient was successfully treated with fulguration of the type-I posterior urethral valve.
• Post-treatment uroflowmetry showed a maximum flow rate of 12 ml/second.
• This case underscores that posterior urethral valves can manifest in adulthood, not exclusively in infancy.

Implications:

• Late presentation of posterior urethral valves necessitates a high index of suspicion in adult males with relevant symptoms.
• While VCUG is the preferred initial imaging, urethrocystoscopy remains crucial for definitive diagnosis and management of PUV.
• This emphasizes the need for broader consideration of congenital urinary tract anomalies in adult urological practice.