Posterior Urethral Valves Treatment in Singapore

• Male infants diagnosed with PUV – The condition exclusively affects boys and is typically diagnosed through prenatal ultrasound or shortly after birth
• Newborns with urinary obstruction symptoms – Including weak urine stream, dribbling, or inability to empty the bladder completely
• Infants with bilateral hydronephrosis – Swelling of both kidneys due to urine backup detected on imaging studies
• Boys with recurrent urinary tract infections – Particularly in the first few months of life
• Children with declining kidney function – Due to chronic obstruction from undiagnosed PUV
• Patients stable enough for endoscopic procedures – With adequate size and health status for surgical intervention

• Severe prematurity – Extremely premature infants may need stabilisation before definitive treatment
• Critical illness – Babies with severe respiratory or cardiac issues may require medical optimisation first
• Urethral size limitations – Very small infants may need temporary drainage until the urethra is large enough for instruments
• Active severe infection – Systemic infections should be controlled before elective procedures
• Bleeding disorders – Uncontrolled coagulation issues need correction before surgery

The decision for immediate treatment versus staged intervention depends on your child’s overall health status, the severity of obstruction, and the presence of complications. Your paediatric urologist will conduct a thorough evaluation to determine the most appropriate timing and approach for treatment.

Primary valve ablation represents the definitive treatment for posterior urethral valves. This endoscopic procedure involves inserting a small camera (cystoscope) and surgical instruments through the urethra to directly visualise and remove the obstructing valve tissue. The surgeon uses either cold knife incision, electrocautery, or laser energy to ablate the valves, creating an open channel for urine flow. This approach is preferred when the infant’s urethra is large enough to accommodate the paediatric cystoscope, typically possible in babies weighing more than 2.5 kilograms.

When immediate valve ablation isn’t feasible, vesicostomy provides temporary urinary diversion. This procedure creates a small opening in the lower abdomen connecting directly to the bladder, allowing urine to drain into a nappy. Vesicostomy is particularly useful for very small or premature infants, those with severe infections, or when significant kidney damage requires immediate decompression. Once the child grows and stabilises, definitive valve ablation can be performed, and the vesicostomy is closed.

For infants with severe bilateral hydronephrosis and compromised kidney function, high urinary diversion through ureterostomy or pyelostomy may be necessary. These procedures create openings that allow urine to drain directly from the ureters or kidney pelvis, bypassing the bladder entirely. While more invasive, these approaches can be life-saving in critical cases and allow time for kidney recovery before addressing the primary valve obstruction.

Modern paediatric cystoscopes with improved optics and smaller diameters enable treatment of increasingly younger infants. Laser technology, particularly holmium laser, offers precise valve ablation with minimal surrounding tissue damage. Video imaging systems provide enhanced visualisation, allowing accurate identification and complete removal of valve tissue while preserving normal urethral structures.

Before the procedure, your child will undergo comprehensive evaluation including blood tests to assess kidney function, urine culture to rule out infection, and imaging studies such as voiding cystourethrogram (VCUG) to confirm the diagnosis and evaluate bladder function. You’ll receive specific instructions about feeding restrictions, typically requiring no milk or formula for 4-6 hours before surgery. Any current medications will be reviewed, and prophylactic antibiotics may be started. The anaesthesia team will examine your child to ensure safety for general anaesthesia.

The valve ablation procedure typically takes 30-60 minutes. After general anaesthesia is administered, your child is positioned appropriately, and the genital area is sterilised. The paediatric urologist carefully inserts the cystoscope through the urethra to visualise the posterior urethral valves. Using the chosen ablation method, the obstructing tissue is systematically removed, ensuring complete valve disruption while protecting surrounding structures. The bladder is thoroughly irrigated to remove debris, and a small catheter may be placed for post-operative drainage.

Following the procedure, your child will be monitored in the recovery room as they wake from anaesthesia. Vital signs, urine output, and pain levels are closely observed. Most children experience minimal discomfort, managed with appropriate pain medication. The urinary catheter, if placed, typically remains for 24-48 hours to ensure adequate drainage and monitor for bleeding. Clear or slightly blood-tinged urine is normal initially. The medical team will ensure stable kidney function through blood tests before discharge, usually within 1-2 days for uncomplicated cases.

During the immediate recovery period, your child may experience mild discomfort during urination, which is normal as the treated area heals. Ensure adequate fluid intake to maintain good urine flow and prevent infection. Watch for warning signs including fever above 38.5°C, inability to urinate, severe abdominal pain, or heavy bleeding in the urine. The catheter, if present, requires careful handling to prevent displacement. Most infants tolerate the recovery well and can resume normal feeding patterns once fully awake.

Continue monitoring your child’s urination pattern, noting stream strength and any straining. Prophylactic antibiotics are typically prescribed to prevent urinary tract infection during initial healing. A follow-up appointment is scheduled within 7-10 days to assess healing and ensure adequate valve ablation. During this visit, a repeat ultrasound may be performed to evaluate kidney drainage. Nappy care requires extra attention to prevent contamination of the healing urethra. Most children show significant improvement in their urinary stream within this period.

Complete healing of the ablation site occurs within 4-6 weeks. Long-term follow-up is essential, as children with PUV require ongoing monitoring throughout childhood. Regular assessments include kidney function tests, bladder function evaluation, and growth monitoring. Some children may develop bladder dysfunction despite successful valve ablation, requiring additional interventions. Annual or bi-annual check-ups continue through adolescence to monitor for late complications and ensure normal development of the urinary system.

Mild bleeding in the urine (haematuria) occurs in most children for several days following valve ablation and typically resolves without intervention. Temporary discomfort during urination is expected as the ablation site heals. Some children experience increased urinary frequency initially as the bladder adjusts to normal emptying. Mild swelling of the urethral opening may cause spraying of the urine stream temporarily. These effects are generally self-limiting and improve within 1-2 weeks with supportive care.

Urethral stricture (scarring causing narrowing) can occur in less than 5% of cases, potentially requiring additional procedures. Incomplete valve ablation may necessitate repeat surgery if residual obstruction persists. Rarely, injury to the external urinary sphincter during ablation can affect continence later in childhood. Severe bleeding requiring transfusion is extremely uncommon with modern techniques. Post-operative urinary tract infection, while preventable with antibiotics, occasionally occurs despite prophylaxis.

These risks are minimised through careful surgical technique, appropriate instrument selection, and the expertise of experienced paediatric urologists. The use of modern visualisation equipment and energy sources has significantly reduced complication rates compared to historical outcomes.