The treatment depends on how the PUV are affecting your child.
Where will my child be treated?
Babies and children with PUV need to stay in hospital for monitoring and treatment.
- Newborn babies are admitted to a specialist neonatal unit, an area of the hospital for newborn babies.
- Older children are admitted to a paediatric unit, a special part of your hospital, for children.
They are discharged home when they are feeding or eating properly and are passing urine normally.
Hospital stay
A team of healthcare professionals will support your child and your family during his treatment. They include a paediatric urologist, a surgeon who treats babies, children and young people with problems of the urinary system.
Read more about your child's healthcare team
Your child’s healthcare team may include:
- neonatologist – a doctor who treats newborn babies who have health problems
- paediatrician – a doctor who treats babies, children and young people
- paediatric urologist – a surgeon who treats babies, children and young people with problems of the urinary system, including the bladder and kidneys
- paediatric nephrologist – a doctor who treats children with kidney problems
- renal nurse – a nurse who cares for children with kidney problems
- continence nurse specialist – a nurse who helps children with going to the toilet
- radiologist – a healthcare professional who uses imaging tests (scans) to help identify a condition; these are used to find out whether your child has PUV and how it is affecting his body, and may also be used during operations
- renal social worker – a professional who supports you and your family, especially with any concerns about money, travel and housing related to looking after your child with kidney disease.
Treating before birth
In most cases, there is no treatment before birth. In a small number of cases, and only when the level of amniotic fluid (or liquor) around the baby has dropped, a surgical procedure called a vesico-amniotic shunt is recommended during pregnancy.
This operation is always done by trained healthcare professionals in a specialist centre. A tube (the shunt) is inserted through the mother’s abdomen and into the baby’s bladder. This aims to drain urine out of the baby’s bladder and into the amniotic fluid. This reduces the effects of pressure and helps the baby’s lungs to develop normally.
Your healthcare team will talk to you about the risks of the procedure and the risks of not doing the procedure, so you can make an informed decision.
Read more about vesico-amniotic shunt
Aim of the operation
Some babies with PUV and other types of blockages cannot pass urine into the amniotic fluid (the liquid around the baby). There is not enough amniotic fluid, which is needed to help the lungs and other parts of the body develop.
The aim of this operation is to drain fluid from the bladder into the amniotic fluid.
What happens
- After giving consent (agreement) for the operation, the mother is admitted to a hospital, usually for less than a day. She is given antibiotics, medicines that help prevent infection, as well as an anaesthetic, a medicine that makes sure she and the baby do not feel pain.
- A hollow needle is inserted through her tummy and uterus, and is guided into the baby’s bladder. An ultrasound scan helps to find the right place.
- A shunt, which is a flexible, shaped tube, is moved down the needle. The shunt is placed between the baby’s bladder and the amniotic fluid. The needle is removed, leaving the shunt inside, to allow any fluid in the bladder to drain away.
- When the baby is born, the shunt is removed.
Risks and complications
- The shunt may move or become dislodged – the mother may need another operation to put in a new shunt.
- The operation may cause problems for babies after birth – such as bladder problems or other developmental problems.
- There may be an increased risk of miscarriage (losing the baby before birth) or preterm birth.
- There may be risks to the mother, such as damage to her organs or infection.
Treating after birth
Supporting breathing in newborn babies
If there are concerns about your baby’s lung development, your healthcare team may give oxygen or use ventilatory (breathing) support equipment to help him breathe.
Draining urine from the bladder (before surgery)
The first treatment for babies and children is to drain urine from the bladder. This helps reduce the risk of long-term problems with the bladder and kidneys.
Urinary catheterisation drains urine from the bladder. This is done using a catheter, a thin, flexible tube. There are two types of urinary catheters:
- urethral catheter – placed through the urethra
- suprapubic catheter – inserted through the tummy skin, using a needle.
Read more about urinary catheterisation
Urethral catheter – a catheter passed into your child’s penis
- Your nurse or doctor cleans your child’s genital area, wearing sterile gloves.
- A small catheter is passed through your child’s urethra and into his bladder. This may feel a little uncomfortable but should not hurt.
- Urine passes through the catheter straight away and is collected in a sterile (completely clean) bag.
Suprapubic catheter – a catheter inserted through the skin into the bladder
- Your child probably has a general anaesthetic, a medicine that helps him go to sleep so he does not feel pain.
- A needle is inserted through his tummy’s skin into the bladder.
- A catheter is passed down the needle so that one end is in his bladder. The needle is removed, leaving the tube in place.
- Urine passes through the catheter and is collected in a sterile bag.
The needle is placed above the genitals - “supra” means above and “pubic” means the genital area.
PUV resection
All boys need surgery to remove the PUV - this is called a PUV resection (“resection” means to cut away). It is done by a paediatric urologist using cystoscopy.
A cystoscope, a tube with a camera, is placed through the urethra. This allows the urologist to look inside it and remove the valves.
Babies usually need to weigh more than 2.5 kg before they can have this operation – depending on the size of their urethra. If your baby is not big enough, your urologist may recommend a temporary procedure – see below.
Risks and complications
Serious complications are very rare. However, no procedure is completely safe, and it is important you understand the risks. Your doctor will speak with you about the possible problems before you consent (agree) to the procedure. The risks include the following.
- Some boys have problems passing urine – this will be checked after the cystoscopy.
- Occasionally, boys get a urinary tract infection after the procedure, and will need to take antibiotic medicine to treat the infection.
- Some boys have visible blood in their urine (haematuria) for a short time after the operation.
What happens
- A general anaesthetic is used to make your child go to sleep so he does not feel pain anywhere in his body. General anaesthetic may be given as a gas that your child will breathe in or it may be injected into a blood vessel. You will see an anaesthetist (a specialist doctor who is trained in giving these medicines) before the procedure, who will explain more.
- The cystoscope is covered with a special gel, and gently passed through your child’s urethra and into his bladder.
- Sterile (completely clean) water is pumped through the cystoscope, so that the urologist can see inside the bladder using the camera and then remove the valves.
After treatment
- Your baby or child will stay in hospital until he is feeding or eating well, passing urine normally and tests suggest that his kidneys are working well.
- A urinary catheter will be left in place for 24–48 hours.
- Your baby or child may need to take antibiotic medicines to prevent or treat any infection caused by the cystoscopy.
Follow-up
A check cystoscopy may be done after some time, to make sure the PUV have been completely removed. If they have not, they will need to resected (cut) away again. Sometimes they will need an alternative treatment.
Vesicostomy (for smaller babies)
In a few boys – especially very small babies – it is not possible do a PUV resection immediately. In some boys who do have a cystoscopy, this procedure fails to remove the valves.
These boys may have a surgical procedure called a vesicostomy. The urologist makes a small cut in the tummy to get to the bladder. A small part of the bladder is sewn to the tummy wall. This allows urine to drain directly from the bladder to the outside of the body – usually into a nappy or a special bag.
When your baby is large enough, he will have a PUV resection. The vesicostomy can then be closed.
Treatments for long-term complications are described in
Questions to ask the doctor or nurse
- What treatment will my baby or child need? Are there any alternatives?
- How will the treatment help my child?
- How long will my child be in hospital?
- How can I help my child prepare for procedures and treatments?
- If the first treatment does not work in my child, what happens next?
- Will my child have long-term kidney problems?