Disorders of the urethra

Most disorders of the urethra in children are congenital in origin and affect boys more commonly than girls. They include; posterior urethral valves (PUV), anterior urethral valves, anterior urethral diverticulum, syringocele, urethral atresia, megalourethra, urethral web, urethral polyp, and urethral duplication. Urethral strictures may be congenital or acquired. Most cases of PUV are now diagnosed prenatally. Postnatal management comprises bladder drainage, correction of any metabolic disturbance, prevention of infection (UTI), and endoscopic valve ablation. Careful follow up is required with the aim of preventing urosepsis and preserving renal function. Persisting bladder dysfunction (‘valve’ bladder) can threaten renal function and should be managed aggressively. Chronic renal failure ultimately affects a third of boys with PUV, of whom 10–20% require renal transplantation during the course of childhood. PUV may also present clinically with recurrent UTI, urinary incontinence, or unexplained lower urinary tract symptoms.