Posterior urethral valve

Case contributed by Dr Maulik S Patel

Presentation

Urinary tract infection.

Patient Data

Age: 5 months
Gender: Male
Ultrasound

Right kidney        

  • 64 X 32 mm       
  • cortico-medullary differentiation is preserved.
  • there is ballooning of calyces and pelvis.
  • there is gross hydroureter up to vesico-ureteric junction. Ureter is tortuous.
  • no calculus or mass lesion is seen.
  • parenchymal thickness at poles - 6 - 7 mm.
  • parenchymal thickness at interpolar region- 3 - 4 mm.

Left kidney           

  • 77 X 33 mm
  • cortico-medullary differentiation is preserved.
  • there is ballooning of calyces and pelvis.
  • there is gross hydroureter upto vesico-ureteric junction. Ureter is tortous.
  • no calculus or mass lesion is seen.
  • parenchymal thickness at poles - 14 - 16 mm.
  • parenchymal thickness at interpolar region- 11 - 12 mm.

Urinary bladder

  • over-distended.
  • no urinarry bladder calculus.
  • wall trabeculations present.

Urethra

  • there is dilated posterior urethra at urinary bladder base (transperineal view).
Fluoroscopy

Micturating cystourethrography (MCU)

Transverse filling defect in the posterior urethra with severe dilatation of posterior urethra, suggestive of posterior urethral valve. 

Urinary bladder is dilated with trabeculated margins. Multiple small urinary bladder diverticula. Significant post void residue is seen.

Grade 5 vesico-ureteric reflux on right side. (severe hydronephrosis and markedly tortuous hydroureter).

Case Discussion

Infant referred with diagnosis of urinary tract infection. Transabdominal ultrasound revealed bilateral hydronephrosis/hydroureter and over-distended, trabeculated walled urinary bladder. Transperineal (trans-pubic symphysis) ultrasound revealed dilated posterior urethra at urinary bladder base.

MCU (courtesy Dr Ninad Shah) revealed posterior urethral valve and right sided grade V reflux.

Surgery revealed posterior urethral valve.

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Case information

rID: 51218
Case created: 7th Feb 2017
Last edited: 30th May 2017
Inclusion in quiz mode: Included

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