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
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:
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