Posterior urethral valves: functional classification.

Among 37 boys with posterior urethral valves (PUV), the clinical courses could be divided into three functional levels of severity which did not always correspond to the traditional anatomic classification of valves. Children with PUV presented at all ages, had varying degrees of renal impairment, and manifested a variety of voiding symptoms. Eleven patients progressed to uremia, but the progression did not correlate with the presence of vesicoureteral reflux or the extent of the voiding dysfunction. Two patients with PUV fathered children eighteen and twenty-one years, respectively, after recognition of their valves. A functional classification of PUV patients is suggested as a way to overcome long-standing bias about the levels of kidney function attainable after primary valve treatment.