Posterior urethral valves
Patient presents for a routine antenatal ultrasound. 35 weeks gestational age by dates. Previous ultrasound at 19 weeks was normal. Presently scan revealed single live male fetus in longitudinal lie with cephalic presentation. Both fetal kidneys were mildly bulky with presence of mild to moderate hydronephrosis and hydroureter. Fetal urinary bladder showed thickened trabeculated wall and dilated posterior urethra. Based on these findings a diagnosis of posterior urethral valves was given. Amniotic fluid index was within normal limits. No fetal ascites seen. No growth retardation.
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The above images reveal bilateral bulky kidneys with hydronephrosis. Dilated tortuous right ureter is visualized. The fetal urinary bladder shows thickened trabeculated wall with a dilated posterior urethra.
Posterior urethral valves are a common cause of bladder outflow obstruction in newborn males. The magnitude of the problem varies in each case. The severity depends on the period of gestation at which it manifests. The earlier it manifests in utero the worse is the antenatal and postnatal prognosis.
In my case the anomaly scan at 20 weeks did not reveal any pyelectasis. First presentation was only after 32 weeks. There were no associated anomalies, no oligohydramnios and no fetal ascites. Hence the postnatal prognosis was good.
The baby was catheterised after birth. There was minimal renal dysfunction which improved after couple of days.
Surgery was planned on day 4 of life.