Persistent lower urinary tract symptoms as an underrecognized presentation of posterior urethral valves

Abstract Background Posterior urethral valves (PUV) are the main cause of lower urinary tract obstruction in boys. Although usually detected prenatally or in early infancy, up to 25% of cases are diagnosed later in childhood [1]. The aim of this study is to examine the association between persistent lower urinary tract symptoms (LUTS) and PUV in older boys. Methods We performed a retrospective observational cohort study of boys aged 7–18 years who were diagnosed with PUV after undergoing diagnostic cystoscopy for persistent LUTS or recurrent urinary tract infections (UTI) between January 2018 and September 2025. Relevant PUV were defined as a ≥ 30% narrowing of the urethral diameter at typical anatomical location. Results In a total of 49 boys, PUV were identified intraoperatively during the study period. LUTS were present in 42 of these patients (91.3%) including incontinence, enuresis, dysuria, voiding difficulties, or urinary retention. Ultrasound abnormalities were observed in 30 patients (65.2%), while 6 patients (13.0%) had normal ultrasound and uroflowmetry findings. Three patients were lost to follow-up. Among the remaining patients, 28 (65.1%) showed complete symptom resolution, 6 (14.0%) had no improvement and all other patients demonstrated partial improvement. Conclusion Our study supports the theory that PUV may be considered as a differential diagnosis for boys presenting with persistent LUTS. While ultrasound and uroflowmetry are valuable tools, their results should be interpreted cautiously, as normal findings do not exclude PUV. In cases of persistent symptoms despite conservative management, cystoscopy should be considered for diagnosis and treatment, although symptom resolution may be delayed following surgery.