Neonate with urinary ascites but no hydronephrosis: unusual presentation of posterior urethral valves

Posterior urethral valves (PUV) are an important cause of paediatric obstructive uropathy. PUV are usually diagnosed by prenatal ultrasonography (US) revealing hydronephrosis and bladder distention. We describe a 17-day-old male infant with abdominal distention who had no hydronephrosis on prenatal US. Laboratory investigations showed serum creatinine of 12 mg/dL, hyperkalaemia and metabolic acidosis. Abdominal US showed large amount of ascites, normal-sized kidneys without hydronephrosis and incompletely distended bladder. Paracentesis revealed clear, yellow ascitic fluid with creatinine level of 27 mg/dL compatible with urinary ascites. Voiding cystourethrogram (VCUG) demonstrated PUV with a dilated posterior urethra, grade 5 right vesicoureteral reflux and a ruptured kidney fornix with peritoneal extravasation of contrast. Foley decompression resulted in normalisation of creatinine within 72 hours. Transurethral resection of PUV was performed, and a repeat VCUG showed recovery of forniceal rupture. This case illustrates an unusual presentation of a potentially life-threatening but treatable cause of urinary tract obstruction.

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Posterior Urethral Valves

The Scientific World JOURNAL ◽

10.1100/tsw.2009.127 ◽

2009 ◽

Vol 9 ◽

pp. 1119-1126 ◽

Cited By ~ 50

Author(s):

Steve J. Hodges ◽

Bhavin Patel ◽

Gordon McLorie ◽

Anthony Atala

Keyword(s):

Early Diagnosis ◽

Urinary Tract Obstruction ◽

Obstructive Uropathy ◽

Posterior Urethral Valves ◽

Urethral Obstruction ◽

Urethral Valves ◽

Lower Urinary Tract Obstruction ◽

Posterior Urethra ◽

Prenatal Hydronephrosis ◽

Long Term Prognosis

The most common cause of lower urinary tract obstruction in male infants is posterior urethral valves. Although the incidence has remained stable, the neonatal mortality for this disorder has improved due to early diagnosis and intensive neonatal care, thanks in part to the widespread use of prenatal ultrasound evaluations. In fact, the most common reason for the diagnosis of posterior urethral valves presently is the evaluation of infants for prenatal hydronephrosis. Since these children are often diagnosed early, the urethral obstruction can be alleviated rapidly through catheter insertion and eventual surgery, and their metabolic derangements can be normalized without delay, avoiding preventable infant mortality. Of the children that survive, however, early diagnosis has not had much effect on their long-term prognosis, as 30% still develop renal insufficiency before adolescence. A better understanding of the exact cause of the congenital obstruction of the male posterior urethra, prevention of postnatal bladder and renal injury, and the development of safe methods to treat urethral obstruction prenatally (and thereby avoiding the bladder and renal damage due to obstructive uropathy) are the goals for the care of children with posterior urethral valves[1].

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Anterior Urethral Valve: Uncommon Association with Renal Duplicity

Journal of Neonatal Surgery ◽

10.21699/jns.v6i2.544 ◽

2017 ◽

Vol 6 (2) ◽

pp. 41

Author(s):

Amina Ben Salem ◽

Ines Mazhoud ◽

Rachida Laamiri ◽

Randa Salem ◽

Hayet Laajili ◽

...

Keyword(s):

Fetal Mri ◽

Cystic Mass ◽

Posterior Urethral Valves ◽

Voiding Cystourethrogram ◽

Urethral Valves ◽

Distended Bladder ◽

Anterior Urethral Valve ◽

Gestational Week ◽

Urethral Valve ◽

Anterior Urethral Valves

Anterior urethral valves (AUVs) is an unusual cause of congenital obstruction of the male urethra, being 15–30 times less common than posterior urethral valves. We present a case of AUV diagnosed at 24th gestational week. Ultrasonography and fetal MRI revealed hydronephrotic kidneys with ureteral duplicity, a distended bladder and perineal cystic mass which confirmed dilated anterior urethra in a male fetus. Diagnosis was confirmed postnatally by voiding cystourethrogram and surgery.

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Prognostic Features in Infants With Obstructive Uropathy Due to Posterior Urethral Valves

The Journal of Urology ◽

10.1016/s0022-5347(17)48899-9 ◽

1985 ◽

Vol 133 (2) ◽

pp. 240-242 ◽

Cited By ~ 86

Author(s):

Barry L. Warshaw ◽

Leonard C. Hymes ◽

Timothy S. Trulock ◽

John R. Woodard

Keyword(s):

Obstructive Uropathy ◽

Posterior Urethral Valves ◽

Urethral Valves ◽

Prognostic Features

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Posterior Urethral Valves in Identical Twins

PEDIATRICS ◽

10.1542/peds.60.5.748 ◽

1977 ◽

Vol 60 (5) ◽

pp. 748-748

Author(s):

R. Lawrence Kroovand ◽

Neal Weinberg ◽

Abbas Emami

Keyword(s):

Case Report ◽

Cesarean Section ◽

Vesicoureteral Reflux ◽

Congenital Anomalies ◽

Monozygotic Twins ◽

Posterior Urethral Valves ◽

Identical Twins ◽

Voiding Cystourethrogram ◽

Intravenous Pyelogram ◽

Urethral Valves

Similar congenital anomalies in siblings are common.1-3 Enuresis,4 vesicoureteral reflux,5 and ureteroceles6 have been reported in identical twins, but posterior urethral valves have not been confirmed in proven monozygotic twins. CASE REPORT Twin boys, weighing 2,380 and 2,637 g, were born by repeat cesarean section to an 18-year-old, gravida 2, para 1 woman. The placenta was monochorionic and diamniotic. Immediately after birth, twin A developed grunting respiration and mild substernal retraction; a firm 6 x 5 cm suprapubic mass was palpated. Suprapubic aspiration produced clear urine, and catheterization decreased the size of the mass. A voiding cystourethrogram and an intravenous pyelogram were diagnostic of posterior urethral valves.

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Unusual presentation of a rare case of posterior urethral valves in a nine-year-old boy

Archives of International Surgery ◽

10.4103/2278-9596.202371 ◽

2016 ◽

Vol 6 (3) ◽

pp. 186 ◽

Cited By ~ 1

Author(s):

Suleiman Lawal ◽

PhilipO Ibinaiye ◽

AhmadT Lawal ◽

MuhammadI Zaria ◽

JosephB Igashi

Keyword(s):

Rare Case ◽

Posterior Urethral Valves ◽

Unusual Presentation ◽

Urethral Valves

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Gross Hematuria as a Presenting Feature of Posterior Urethral Valves in a Neonate with Normal Antenatal Sonograms

Medicines ◽

10.3390/medicines7010005 ◽

2020 ◽

Vol 7 (1) ◽

pp. 5

Author(s):

Ratna Acharya ◽

Romano DeMarco ◽

Kiran Upadhyay

Keyword(s):

Obstructive Uropathy ◽

Kidney Injury ◽

Posterior Urethral Valves ◽

Gross Hematuria ◽

Initial Manifestation ◽

Fetal Hydronephrosis ◽

Urethral Valves ◽

Study Results ◽

Male Neonate ◽

High Index Of Suspicion

Background: Posterior urethral valves (PUVs) are usually suspected during antenatal sonograms or by postnatal evidence of bilateral hydronephrosis with enlarged bladder. Gross hematuria as an initial manifestation of PUV with a history of normal antenatal sonogram is very rare. Methods: This is a retrospective chart study. Results: We describe a nine-day-old male neonate who presented with gross hematuria and was later found to have a urinary tract infection (UTI) and severe acute kidney injury (AKI). The mother apparently had normal antenatal sonograms with no evidence of fetal hydronephrosis. The child did not have postnatal renal bladder sonogram done until gross hematuria occurred at Day 9 of life. Sonogram showed bilateral severe hydronephrosis and hydroureter with enlarged bladder. The patient underwent ablation of the PUVs after initial bladder decompression with indwelling urethral catheterization. His AKI resolved after prompt treatment of UTI and PUV ablation. Conclusions: This report emphasizes the importance of a high index of suspicion for obstructive uropathy in a newborn with gross hematuria irrespective of prenatal sonogram findings.

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Unrecognized anterior urethral valves as a cause of renal failure

Open Medicine ◽

10.2478/s11536-012-0083-z ◽

2013 ◽

Vol 8 (3) ◽

pp. 343-345

Author(s):

Vladimir Kojovic ◽

Miroslav Djordjevic ◽

Marta Bizic ◽

Marko Majstorovic

Keyword(s):

Wide Spectrum ◽

Upper Urinary Tract ◽

Posterior Urethral Valves ◽

Voiding Cystourethrogram ◽

Urethral Valves ◽

Appropriate Treatment ◽

Anterior Urethral Valves ◽

Stage Renal Disease ◽

End Stage ◽

Cutaneous Vesicostomy

AbstractCongenital obstruction of the male urethra is usually caused by posterior urethral valves. Anterior urethral valves (AUV) represent a rare anomaly with a wide spectrum of presentation varying from mild voiding difficulties to end-stage renal disease. Prompt diagnosis and appropriate treatment is essential to prevent renal impairment. We report the case of a 13 month-old boy who presented with deterioration of kidney function caused by unrecognized AUV disorder. Temporary cutaneous vesicostomy was necessary to protect the upper urinary tract from further damage and to stabilize renal function. Even though a voiding cystourethrogram (VCUG) demonstrated obstruction of distal urethra, AUV were initially overlooked but finally diagnosed on additional VCUG followed by urethroscopy.

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