Case of the Week: February 12-February 19, 2002

Newborn Male with Poor Urinary Stream.

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Case Details

VCUG: Moderate dilatation of the posterior urethra At the level of the obstructing valve (Actual valve tissue may not be seen) Abrupt transition from dilated posterior urethra to narr

Answer

Diagnosis: Posterior Urethral Valve

DIFFERENTIAL DIAGNOSIS:  Detrusor Spincter Dyssynergia

CLINICAL PRESENTATION:

  • Severity of obstruction determines age at presentation and clinical symptoms

  • Approximately 1/3 present at each stage, below:

    • Neonatal: Bladder distension, hydronephrosis, urinoma, urine ascites, in utero hydramnios and pulmonary hypoplasia

    • Infant: UTI, sepsis, renal insufficiency/failure, vomiting, failure to thrive, jaundice, palpable pelvic mass (bladder)

    • Child: Abnormal voiding patterns, hesitancy, strining, poor stream, large post-void residual, renal insufficiency/ failure

TREATMENT:

  • Endoscopic valve ablation

  • Fetal surgery sometimes performed in cases of severe oligohydramnios - vesico-amniotic shunt 

PROGNOSIS:

  • Varies with degree of renal dysplasia - related to chronic obstruction and VU reflux

  • May progress to need for renal transplantation

  • Long term: poor bladder compliance, small capacity bladder, voiding dysfunction

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VCU Department of Pediatric Radiology Virginia Commonwealth University VCU Medical Center