Concomitant Anterior and Posterior Urethral Valves in an Infant: Diagnostic Challenges and Endoscopic Management

A BSTRACT Concomitant anterior urethral valves and posterior urethral valves (AUV and PUV) are extremely rare congenital causes of bladder outlet obstruction in boys and can lead to significant renal damage if undiagnosed. A 10-month-old male, antenatally detected with bilateral hydroureteronephrosis, presented with dribbling and a weak urinary stream since birth. Micturating cystosurethrogram (MCU) showed a trabeculated bladder with left vesicoureteric reflux and a pseudodiverticulum inside the anterior urethra, forming an obtuse angle with the ventral urethra, suggestive of an AUV. Cystoscopy confirmed both AUV and PUV, which were fulgurated in a single session with good postoperative recovery. A well-performed MCU and complete cystoscopic evaluation are essential to detect coexisting lesions, as missed AUVs may cause persistent obstruction even after PUV ablation. Awareness of this rare dual pathology facilitates early diagnosis and treatment, preventing progressive bladder and renal dysfunction.