Posterior urethral valves in children: from antenatal diagnosis to long-term management

Abstract Posterior urethral valves (PUV) are the most common congenital cause of bladder outlet obstruction in male infants, with significant implications for renal and bladder function. Early antenatal diagnosis through ultrasound (USG) and fetal MRI allows timely planning for postnatal interventions, parental counselling, and risk stratification. Postnatal management focuses on stabilisation, bladder decompression, valve ablation, and ongoing surveillance of renal and bladder function. Despite early intervention, many children develop bladder dysfunction, chronic kidney disease (CKD), or end-stage renal disease (ESRD), highlighting the need for structured follow-up. Pharmacotherapy, including antibiotics, anticholinergics, alpha-blockers, and antihypertensives, complements surgical management and must be titrated and monitored according to renal function, blood pressure, and urodynamic findings. Parental education on clean intermittent catheterisation and overnight bladder drainage is essential to prevent complications and improve long-term outcomes. This narrative review synthesises current evidence on antenatal prognostication, postnatal surgical strategies, pharmacologic management, and follow-up, emphasising practical guidance for paediatric urologists. The proposed algorithms and figures are intended to provide a useful clinical framework rather than a rigid protocol and should be adapted according to institutional resources and individual patient factors. It also addresses frequently encountered clinical questions, such as the optimal timing of interventions, indicators for additional surgical procedures, dose adjustment of medications, and monitoring strategies. Understanding the spectrum of PUV from fetal life to adolescence is crucial for optimising outcomes, preventing renal deterioration, and ensuring a structured, multidisciplinary approach tailored to each patient.