The disease refers to mechanical obstruction within the urethral lumen caused by congenital factors, but the true etiology remains unclear. In severe cases, besides the urethral valve membrane, it is often accompanied by kidney and lung malformations, and most affected infants do not survive. The hallmark of posterior urethral valve disease is difficulty in normal urination through the urethra, leading to a series of complications. However, inserting a catheter from the urethral orifice into the bladder can proceed smoothly without apparent obstruction. Diagnosis of the disease primarily relies on urethrography and urethrocystoscopy.

bubble_chart Etiology

[Differential Diagnosis]

[Epidemiology] [Efficacy Evaluation]

1. Cured: Membrane resection, smooth urination, infection controlled, renal function improved.

2. Improved: Urination improved.

3. Not cured: Symptoms not relieved, still experiencing difficulty urinating.

bubble_chart Clinical Manifestations

1. If symptoms appear during infancy, the general condition of the body is usually poor, with developmental delays and poor appetite.

2. The child cries during urination, experiences difficulty urinating, and if infection occurs, symptoms such as fever may appear.

3. Physical examination reveals an abnormally distended bladder, and if hydronephrosis is present, a cystic mass may be palpable in the upper abdomen.

4. A catheter can be smoothly inserted into the bladder, draining a large amount of urine and relieving the symptoms of urinary retention.

[Ancillary Examinations]

To confirm the diagnosis of congenital urethral valve membrane, other conditions causing lower urinary tract obstruction must be ruled out, such as bladder neck obstruction, hypertrophy of the verumontanum, lithiasis, and congenital vesicoureteral reflux. To differentiate these conditions, urethrocystoscopy is essential. This examination allows direct visualization of the aforementioned pathologies and can simultaneously remove the urethral valve membrane during the procedure, achieving therapeutic goals.

1. Difficulty in urination since childhood, with dribbling or incontinence. Long-term urinary retention and recurrent urinary tract infections can lead to renal impairment, resulting in symptoms of chronic renal insufficiency.

2. No obstruction is found during urethral catheterization. In severe cases, urography may reveal bilateral hydronephrosis and decreased renal function.

3. Voiding cystourethrography can show the site of obstruction, proximal urethral dilation, and an irregularly enlarged bladder. In severe cases, vesicoureteral reflux may be present.

4. A urethral valve hook can be used to catch the valve membrane for definitive diagnosis.

bubble_chart Treatment Measures

1. Perform electrocoagulation of the urethral valve membrane using a valve membrane hook.

2. Perform direct vision transurethral valve membrane resection.

3. The use of antibiotics is primarily aimed at preventing infection.

4. If renal function is not significantly impaired, oral antibiotics may be administered; if renal insufficiency or infection is present, intravenous medication should be the main approach, along with renal protective therapy. {|103|}