Most boys with posterior urethral valves (PUV) are diagnosed with their infravesical obstruction prenatally, giving us the opportunity to minimize the effects of this obstruction on the bladder and kidneys. Currently, antenatal intervention provides a significant advantage in terms of perinatal survival, but there is no evidence that it improves renal function (RF) prognosis in these patients. Despite endoscopic valve ablation or urinary diversion once the diagnosis is confirmed postnatally, the embryologic insult to the bladder and kidneys resulting from the intrauterine obstruction will decide the prognosis of these patients. Although the mortality has decreased significantly over the last years, the deterioration in RF continues to pose a serious problem, leading to chronic kidney disease (CKD) before adolescence in approximately 30%. However, other factors besides renal dysplasia have also been associated with poor long-term RF outcome, and the early treatment of all of them may delay or even avoid the onset of end-stage renal disease (ESRD). When the patient does enter ESRD, renal transplant is the best option and the valve-affected bladder does not pose an increased risk for graft loss compared with controls, provided the bladder dysfunction has been treated. There are very few published studies regarding fertility and sexual function in PUV patients, but it has been noted that fertility may be impaired in this population.