Tubes everywhere!
Remember…way back…(WAY WAY back for old nurses like me). Remember way back to your pre-nursing days and your A&P class? You know what I’m talking about. Those poor frogs…I’ll mention those poor critters at the end of this article. From the inner workings of our cells to the inner workings of each and every body system, we learned all about this and that. And, with all those systems, it’s amazing that stuff doesn’t go wrong more often with more folks. However, this “amazing” thought isn’t a thought that parents of children who have problems and the subsequent challenges to overcome. We find ourselves either asking ourselves one of two questions. Either, “How did I get so lucky?” Or, “Why me? Why my child?”
What are little boys made of, made of?
What are little boys made of, made of?
What are little boys made of?
“Snaps and snails, and puppy-dogs’ tails;
And that’s what little boys are made of.”
What are little girls made of, made of?
What are little girls made of?
“Sugar and spice, and all that’s nice;
And that’s what little girls are made of.”
— The Real Mother Goose (1916)
Posterior urethral valves are a problem in the urethra in boys. There are some hints of documentation of PUV occurring in girls. However, you will likely not ever see this issue in a girl. Is it genetic? Probably not, but they have seen twin boys born with this issue. The “why’s” will always be there. Basically, this condition is male-specific (though rare) and is usually identified while the child is still in the womb.
Let’s back up and look at anatomy.
The genitourinary system, or urogenital system is the organ system of the reproductive organs and the urinary system. We’re not concerned with the reproductive organs…well…we are, but not for this article.
The kidneys are one of the body’s washing machines (liver being the other). The blood runs through the kidneys and the kidney’s infrastructure. The stuff our body does not need is filtered out and urine is formed. The urine (Pee Pee) drips and drops down the ureters and into this large, muscular sac called the bladder. And thank goodness for the bladder; we’d just drip pee pee all day without this convenient holding tank. When the bladder fills to a certain point, cool stretch receptors “trigger” the brain and it starts releasing valves and notifying you that you need to go for a short bathroom break.
And, Sometimes Things Go Wrong
About 1 in 8,000 boys will develop PUV by “chance.” Is it genetic? They are not quite convinced yet. This may be one of those conditions that just “is what it is.” Some folks don’t like that saying, “it is what it is.” That saying indicates something happening that is outside of our control. And that’s why PUV is definitely an “it is what it is” condition.
Though this condition is called “valves,” they are not “normal” valves and are not suppose to form. It is a congenital condition. But, we school nurses aren’t usually involved with the child at the prenatal stage or most of the years between birth and five-years-old. By the time a child with PUV that ends up at your school they may very well need accommodations for some of the symptoms this condition may cause including both urinary frequency and new onset of urinary incontinence. I would even venture into musculoskeletal issues that may be identified. And how do we move from this being a genitourinary issue to a musculoskeletal issue? As a matter of fact, there may be a slew of other conditions that have occurred during the first 5-6 years of life that you will have to address as well. And all because of some little flaps and twists of tissue. Read on…
Secondary Vesicoureteral Reflux (VUR)
In college, we lived in a little house at the end of a lane where the toilet would, on an occasion, back up into the bathtub. Yes…it was just like you are imagining in your mind right now…just like that…gross… Roots from an aged tree had gotten into the underground pipes and would block the drainage to the city’s septic lines at the road. So, what was “