Posterior Urethral Valves in a Healthy-Appearing Athletic Adult: A Case Report

TL;DR

A healthy 18-year-old athletic male was diagnosed with rare posterior urethral valves, leading to kidney damage, highlighting the importance of thorough medical histories.

Contribution

This case report highlights the rare delayed presentation of PUV in a healthy adult and emphasizes the need for comprehensive patient histories.

Findings

An 18-year-old male with no significant medical history was diagnosed with posterior urethral valves after presenting with acute renal failure.

The patient exhibited severe bilateral hydronephrosis and bladder diverticula, indicating long-term kidney damage.

Laser valve ablation surgery was performed, but it could not reverse existing chronic kidney damage.

Abstract

Posterior urethral valves (PUV) are a congenital malformation of the male urethra where the posterior opening connecting to the bladder is covered by membranous folds. Most cases are diagnosed antenatally, with postnatal cases typically diagnosed and surgically repaired within the first years of life. Delayed presentation beyond infancy is rare, with presentation into adulthood being exceedingly rare, especially in the United States. We present a case of an 18-year-old healthy-appearing athletic male who presented with delayed presentation of PUV. This patient with no significant past medical history presented to the emergency room upon referral by his primary care physician, who denoted incidental findings of elevated blood pressure and acute renal failure at his annual physical examination. This led to further investigation, including a full renal blood workup, bilateral renal ultrasound, and voiding cystourethrogram, which revealed severe bilateral hydronephrosis, cortical thinning, and diverticula of the bladder, prompting a diagnosis of PUV. The patient underwent laser valve ablation surgery, although unfortunately, the surgery will prevent symptoms from progressing but is unlikely to reverse the current stage of chronic kidney damage. Even though delayed presentation of PUV is rare, it is important to recognize that patients may have a long history of renal complaints and may have normalized and internalized their symptoms. Physicians should take detailed and holistic medical histories and create a safe, non-judgmental environment to build rapport with young adult patients, ensuring early and effective medical intervention.

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