Comparative Profile of Pediatric Patients with Lower Urinary Tract Symptoms (LUTS) with and without Posterior Urethral Valve

Background: Posterior urethral valves (PUV) are the most common cause of congenital lower urinary tract obstruction in boys and are an important cause of bladder dysfunction and chronic kidney disease. Children with lower urinary tract symptoms (LUTS) may have PUV or non-obstructive functional and neurogenic etiologies, but comparative data between these groups are limited, particularly from developing countries.

Objectives: To compare the clinical, urodynamic, radiological, and renal profiles of pediatric patients with LUTS with and without posterior urethral valves.

Methods: This retrospective observational study was conducted at multiple tertiary care centers in North India between July 2022 and June 2025. Male children aged ≤18 years presenting with LUTS and undergoing ultrasonography, voiding cystourethrogram, and urodynamic evaluation were included. Patients were grouped as PUV (n=20) or non-PUV LUTS (n=53). Renal function was assessed using serum creatinine and estimated glomerular filtration rate (eGFR), and chronic kidney disease (CKD) was staged according to KDIGO guidelines. Bladder morphology, post-void residual urine, vesicoureteral reflux (VUR), and urodynamic parameters were compared. Statistical analysis was performed using appropriate parametric and non-parametric tests, with odds ratios calculated for major outcomes.

Results: Children with PUV had significantly higher prevalence of recurrent urinary tract infections (65% vs 39.6%, p=0.048), neurogenic bladder (35% vs 11.3%, p=0.019), and bowel-bladder dysfunction (40% vs 18.9%, p=0.041). PUV patients had significantly lower eGFR (73.8 ± 28.4 vs 91.2 ± 24.9 ml/min/1.73 m², p=0.014) and higher CKD stage ≥3 (35% vs 9.6%, p=0.008). Bladder wall thickening, diverticula, trabeculations, and post-void residual urine were significantly more frequent in PUV. VUR was present in 60% of PUV compared to 26.4% of non-PUV patients (p=0.007), with bilateral reflux in 40% vs 11.3% (p=0.004). Urodynamic studies showed markedly lower bladder capacity, poorer compliance, higher detrusor pressures, lower flow rates, and greater outlet obstruction in PUV (all p<0.001). PUV was associated with 4–5-fold higher odds of CKD, VUR, bladder trabeculation, and neurogenic bladder.

Conclusion: Posterior urethral valves are associated with severe bladder and renal morbidity in children with LUTS, underscoring the need for early diagnosis, comprehensive urodynamic evaluation, and long-term multidisciplinary care.