Clinical profile of children with posterior urethral valve (PUV) in a tertiary center in Nepal: a retrospective cross-sectional study.

Background: Posterior urethral valves (PUVs) are the most common cause of congenital bladder outlet obstruction in boys and a major contributor to pediatric chronic kidney disease and end-stage renal disease. Although early antenatal detection has improved outcomes in high-resource settings, delayed presentation remains common in low-resource countries. Data from Nepal on the clinical spectrum and management of PUV are limited, necessitating local evidence to guide timely diagnosis and follow-up. This study aims to describe the clinical profile and diagnostic characteristics of children with PUV managed at a tertiary center in Nepal and to identify factors associated with residual valves after endoscopic ablation. Methods: This retrospective observational study included boys younger than 16 years with confirmed PUV who were managed at the Pediatric Surgery Unit of Tribhuvan University Teaching Hospital over a 5-year period. Demographic details, clinical presentation, laboratory parameters, imaging findings (ultrasound and voiding cystourethrogram), cystoscopic characteristics, and postoperative outcomes were extracted from medical records. Statistical analyses assessed associations between residual valve presence and clinical or imaging variables, with Results: Fifty children were included; 46% presented within the first 5 months of life, whereas 44% were older than 11 months at diagnosis. Common symptoms were crying during micturition (66%), poor urinary stream (58%), and dribbling (32%). Vesicoureteral reflux was present in 46%, with high-grade reflux in 36%. Type I PUV predominated (74%). Residual valves following initial ablation were detected in 18% of patients and were significantly associated with older age, acute kidney injury, high-grade vesicoureteral reflux, and type I valve morphology. Conclusions: PUV in Nepalese children often presents late with established urinary tract changes. Early diagnosis, prompt ablation, and careful postoperative surveillance are essential to reduce residual obstruction and long-term renal morbidity.