Posterior urethral valves (PUV) are the most common congenital cause of bladder outlet obstruction in children and a leading cause of end-stage renal failure. There should be a high index of suspicion in twin pregnancy even if only one of the twins is suspected of bladder outlet obstruction. The association of posterior urethral valves in a patient with anorectal malformation should be suspected in case of associated oligohydramnios or oliguria postnatally. We explore the difficulty in achieving a diagnosis and the final management. In this case series, we report on two cases of PUV associated with anorectal malformations along with a case of PUV in monochorionic diamniotic twins. Known associations include cardiac malformations and gastrointestinal abnormalities. Posterior urethral valves are a common cause of congenital bladder outlet obstruction.
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