[Posterior Urethral Valves: A Pediatric Urological Condition with Lifelong Relevance]

Posterior urethral valves (PUV) are rare congenital malformations affecting both the upper and lower urinary tract and can lead to severe long-term complications. Thanks to advances in prenatal diagnostics, neonatal care, and pediatric urological-nephrological management, an increasing number of patients now reach adulthood. Long-term outcomes are primarily determined by the extent of prenatal renal dysplasia as well as the early recognition and targeted management of bladder dysfunction. Care of adult PUV patients remains challenging, as many adult urologists have limited experience and evidence-based guidelines for long-term management are lacking. Adult PUV patients constitute a clearly defined high-risk cohort with characteristic urological and renal sequelae, including persistent or secondary progressive bladder dysfunction with clinically significant lower urinary tract symptoms (LUTS) and an increased risk of progressive chronic kidney disease (CKD) up to end-stage renal disease (ESRD). In cases of ESRD, kidney transplantation may be required; optimized bladder function is crucial to preserve graft function, and reconstructive procedures, such as bladder augmentation, may be necessary.Bladder function evolves throughout life: initially hypertrophic and hyperactive, it may later decompensate, leading to hypocontractility or atony ("myogenic failure"). Adult patients often report voiding difficulties, post-void residual urine, urgency, incontinence, and recurrent urinary tract infections, which can significantly impair quality of life, self-esteem, and sexual self-efficacy. Treatment is guided by the individual urodynamic phenotype and may include conservative, pharmacological, and, when necessary, interventional strategies.Sexual function and fertility are preserved in most patients; limitations primarily occur in advanced CKD or complex bladder management scenarios. Psychosocial burdens related to altered body image, incontinence, catheterization, or concerns regarding partnership and family planning are common and should be addressed early. Optimal care for PUV patients requires lifelong, interdisciplinary follow-up, structured transition from pediatric to adult care, and close coordination between urology, nephrology, pediatric urology/nephrology, and transplant medicine to ensure long-term preservation of renal function, quality of life, and graft survival.