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Jack S. Elder, MD,
Ellen Shapiro, MD

Posterior urethral valves (PUV) comprise the most common congenital anomaly causing bladder outlet obstruction in boys, with an incidence of 1 in 5000 to 1 in 8000 male births. Although the majority of boys with PUV are diagnosed before birth, in 24% to 45% renal insufficiency will develop during childhood or adolescence. PUV are the most common obstructive cause of end-stage renal disease in children.


At 5 to 6 weeks’ gestation, the orifice of the mesonephric duct normally migrates from an anterolateral position in the cloaca to Müller’s tubercle on the posterior wall of the urogenital sinus. This event occurs simultaneously with the division of the cloaca. Remnants of the mesonephric duct normally remain as small distinct, paired lateral folds termed the inferior urethral crest and plicae colliculi.When the insertion of the mesonephric ducts into the cloaca is anomalous or too anterior, normal migration …