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. A team of healthcare professionals will support your child and your family during his treatment. They include a paediatric nephrologist (a doctor who treats children with kidney problems) and a paediatric urologist (a surgeon who treats babies, children and young people with problems of the urinary system).
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.
Treating before birth
In most cases, no treatment is needed before birth. In a small number of cases, and only when the level of amniotic fluid around the baby has dropped, a surgical procedure called a vesico-amniotic shunt is recommended during pregnancy.
A flexible tube (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 helps the baby’s lungs to develop normally.
Your healthcare team will talk to you about the procedure so you can make an informed decision.
Treating after birth
Supporting breathing in newborn babies
If there are concerns about your baby’s lung development, your healthcare team may give them oxygen or use ventilatory (breathing) support equipment to help them 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. Your child’s doctor will give you more information about this if needed.
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.
Some babies are too small or unwell to have this operation so your urologist may recommend a temporary procedure called a vesicostomy instead – 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.
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. This is very common and usually settles after a few days.
Follow-up
Another cystoscopy may be done to make sure the PUV have been completely removed. If they have not, they will need to resected (cut) away again.
Vesicostomy (for smaller babies)
In a few boys – especially very small babies – it is not possible to do a PUV resection immediately. In other cases, a cystoscopy 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.
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?