The posterior urethral valves revisited: embryological correlation, clinical classification, and risk stratification of the spectrum

Annals of Pediatric Surgery

Table 1 Clinical classification of PUV into distinct subgroups based on clinical criteria and response to therapy

Group	Clinical features
A	Changes confined to the lower urinary tract (posterior urethra and urinary bladder) with normal ureters and kidneys. [(I) Responding to therapy ⁱ. (II) Not responding to therapy.]
B	Involvement of the upper tracts, in addition to the lower tract changes. (Hydroureteronephrosis/megaureter/VUR) [(I) Responding to therapy ⁱⁱ. (II) Not responding to therapy.]
C	Evidence of renal parenchymal damage ⁱⁱⁱ. (Inherent renal dysplasia/acquired renal scarring or abnormal renal function tests). [(I) Responding to therapy ^iv. (II) Not responding to therapy.]
D	Evidence of systemic complications ^v.
E	End-stage renal disease/chronic renal failure.

ⁱPosterior urethral dilatation and bladder changes decreasing on serial VCUG and Cystoscopy
ⁱⁱHydroureteronephrosis and/or VUR decreasing on serial investigations
ⁱⁱⁱRenal cortical thinning on USS, decreased cortical function on isotope study
^ivFall in elevated RFT, absence of progressive renal scarring
^vMetabolic acidiosis/nephrogenic diabetes insipidus/hypertension/renal osteodystrophy/growth failure