Landscape of posterior urethral valve management in Africa: current practices, challenges, and prospects in referral centres

Abstract Introduction Posterior urethral valves (PUV) are leading congenital lower urinary tract obstruction in boys and remain an important cause of paediatric chronic kidney disease. In Africa, management of PUV is challenged by delayed diagnosis and limited access to specialised care, and unequal availability of diagnostic and therapeutic resources. This study aimed to evaluate current practices, challenges and perspectives in the management of PUV across Africa. Methods A multicentre observational study was conducted by Modern Urology For Africa among 31 centres in 17 African countries involved in management of PUV. Data were collected using a standardised online questionnaire and distributed to urologists and paediatric surgeons across the continent. The survey explored the organizational characteristics, expertise in paediatric urology, diagnostic and therapeutic resources, management practices, barriers to care, and future priorities. Descriptive statistical analysis was performed using frequencies, percentages, means or median as appropriate. Results Dedicated paediatric surgery departments were available in 74.2% of centres. Expertise in paediatric urology was rated as low or moderate in 93.5% of centres. PUV diagnosis occurred most commonly between 1 and 5 years of age (54.8%), whereas prenatal diagnosis was reported as uncommon or absent in most centres (80.6%). Ultrasonography combined with CT scanning was the most widely available diagnostic modality (80.6%), while paediatric endoscopy was unavailable in 38.7% of centres. Endoscopic valve ablation was performed in a limited number of institutions (29.0%). The main barriers to optimal care included lack of endoscopic equipment (45.2%), financial constraints for families (32.3%), and infrastructural limitations (22.6%). Conclusion PUV management in Africa remains highly heterogeneous and constrained by limited subspecialised expertise, delayed diagnosis, and inadequate access to paediatric endourological resources. Strengthening paediatric urology training, improving infrastructures, expanding endoscopic capacity, and developing regional referral network are essential to improve early diagnosis, standardise care, and optimise outcomes for children with PUV across Africa.