# Delayed Diagnosis of Posterior Urethral Valves in a 14-Year-Old Adolescent

## TL;DR

A 14-year-old boy was diagnosed with posterior urethral valves and vesicoureteral reflux after experiencing recurrent urinary issues, and he was successfully treated with endoscopic procedures.

## Contribution

This case highlights the importance of diagnosing congenital urinary tract anomalies in adolescents who present with persistent symptoms.

## Key findings

- A 14-year-old boy was found to have posterior urethral valves and bilateral vesicoureteral reflux.
- Endoscopic ablation of the valves and correction of reflux led to symptom resolution and no recurrence over 2 years.
- Delayed diagnosis in adolescence is rare but possible, emphasizing the need for thorough urinary evaluation in symptomatic adolescents.

## Abstract

Background and Clinical Significance: Posterior urethral valves are rare congenital anomalies characterized by persistent urethral mucosal folds and causing varying degrees of obstruction. The increasing use of prenatal ultrasound has contributed to the early diagnosis of posterior urethral valves (PUV), a condition associated with a severe prognosis, as approximately one-fifth of affected patients develop chronic kidney disease. Early diagnosis and intervention—namely, valve ablation—provide obstruction alleviation and renal function preservation. Therefore, it is uncommon for patients to be diagnosed in adolescence or adulthood, when patients usually present with frequency, voiding dysfunction, daytime incontinence, enuresis, recurrent urinary tract infections, and renal insufficiency. Case Presentation: We present a 14-year-old adolescent with recurrent urinary tract infections. A thorough medical history, clinical examination, and standard imaging revealed bilateral vesicoureteral reflux and posterior urethral valves. The patient underwent urethrocystoscopy for diagnostic and therapeutic purposes and posterior urethral valve ablation. Despite these interventions, the persistence of his symptoms necessitated endoscopic correction of the vesicoureteral reflux and circumcision. During the 2-year follow-up, the patient remained asymptomatic. Conclusions: Symptomatic adolescent boys should undergo a standard urinary evaluation to identify undiagnosed congenital urinary tract diseases and maintain renal and bladder function.