Presentation
Gravida 3, presents with 35 weeks of amenorrhea.
Patient Data
Obstetric ultrasound scan revealeevere bilateral fetal hydronephrosis resulting in enlarged kidneys with renal parenchymal thinning. No renal parenchymal cystic spaces. Dilatation of both ureters in their entire length. Overdistended (volume 48 cc) and thick-walled urinary bladder. A small cystic structure communicates with the urinary bladder neck, a dilated posterior urethra. 2nd cine-loop (coronal plane) shows dilatation of the posterior urethra.
Oligohydramnios (AFI ; 4). No other structural abnormality. Normal fetal growth. Normal Doppler study. (images not uploaded)
The micturating cystourethrogram shows a transverse filling defect in the posterior urethra with severe dilatation of the proximal urethra. Normal anterior urethra. Urinary bladder wall trabeculations with multiple small diverticula. Grade 5 right vescico-ureteric reflux. No vescico-ureteric reflux on left side.
Case Discussion
Gravida 3 female with 35 weeks of amenorrhea came for a 3rd trimester scan. The previous 13th week and 20th week scans were normal. Bilateral mild hydronephrosis was noted at the 30th week scan. The present study reveals bilateral renal severe backpressure changes, dilated thick-walled urinary bladder, a keyhole sign, and oligohydramnios. Findings favor the posterior urethral valve. The Lower Segment Cesarian Section delivered the baby.
Cystoscopic fulguration was done on the second day after delivery.
Fluoroscopy study courtesy: Dr. Ninad C. Shah
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