Fetal Ascites and Posterior Urethral Valves. A Case Report and Literature Review (original) (raw)
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ANTENATAL DIAGNOSIS OF POSTERIOR URETHRAL VALVE: A CASE REPORT.
The posterior urethral valve (PUV) is the most frequent cause of end-stage renal disease in male children. The echographic appeals that may suspect this malformation are variable. We report the case of a 33 year old patient, without a specific antecedent. In whom the T1 ultrasound screening reveals an aspect of megavessy with renal dilation. The T2 ultrasound shows an enlarged bladder with a thickened wall. Both kidneys have a visible cortex, abnormal echostructure marked by bilateral ureter-pyelo-calicial dilatation. Amniotic fluid index is normal. The T3 Ultrasound reveals a persisting bilateral ureter-pyelo-calcicial dilatation and a large bladder with thick walls. The Delivery was natural at 37 SA + 5J and the development of the baby was normal.
Anterior Urethral Valves-An Unusual Cause of Hydrops Fetalis
Anterior Urethral Valves (AUV) are a less common cause of lower urinary tract obstruction than Posterior Urethral Valves (PUV). AUV may present with symptoms of mild to severe obstruction and renal impairment at any age. Here we report possibly the first case of AUV presenting as hydrops fetalis. This late preterm infant presented with postnatal presentation of hydrops leading to respiratory failure. There was marked ascites, a left-sided inguinal hernia and hypospadias. Immune and most non-immune causes of hydrops were ruled out. Mild hydronephrosis with poor renal function and dependency on bladder catheterization for urinary output remained. While the ascites gradually improved, the bladder outlet obstruction persisted without evidence for PUV. Voiding cystourethrogram (VCUG) led to suspicion of AUV which was confirmed and managed with cystoscopic valve ablation. We review the physiology, clinical presentations, treatment and outcomes of AUV in the context of a differential diagnosis based on neonatal ascites values.
Ultrasound evaluation of prognosis in fetuses with posterior urethral valves
Journal of Pediatric Surgery, 2011
Purpose: The aim of this study was to evaluate the ability of prenatal ultrasound markers to predict postnatal renal prognosis in fetuses with posterior urethral valves. Methods: Medical files on fetuses with prenatal diagnosis of posterior urethral valves from 2000 to 2006 were reviewed retrospectively. Data from prenatal follow-up included gestational age at diagnosis, ultrasound renal parenchyma evaluation, and presence and time of oligohydramnios onset. Prenatal parameters studied were correlated to postnatal renal function. Results: Thirty-one male fetuses were included. Six pregnancies were terminated. Of the remaining 25 pregnancies that were continued, 4 children had abnormal creatine and 21 normal creatinine levels at follow-up. Presence and time of oligohydramnios onset did not differ between groups (P = .43). Ultrasound detected bilateral renal abnormalities in 3 fetuses (75%) with altered renal function, and 10 fetuses (55%) with normal creatinine, at follow-up. Conclusions: None of the ultrasound parameters evaluated were able to reliably predict postnatal renal function.
Renal dysplasia in children with posterior urethral valves: a primary or secondary malformation?
Pediatric Surgery International, 2002
Routine prenatal ultrasound examination of the urogenital tract is of importance in patients with posterior urethral valves (PUV), because the renal function and long-term prognosis of these patients depend on early diagnosis and subsequent therapy. Opinion is divided as to whether the often-observed association of PUV with renal dysplasia represents a primary malformation or a secondary pathology caused by recurrent infections. These aspects should have an influence on therapeutic consequences and optimal timing of therapy in order to preserve long-term renal function. The histology of kidney specimens from 13 children with PUV who underwent nephrectomy was reviewed to attempt to differentiate between primary dysplastic malformations and secondary pathologies. Clinical data were analyzed and compared with the histologic findings. The average age at nephrectomy was 29 months (range 3-158 months). Approximately 80% of the specimens showed primary dysplastic malformations (mesenchymal or fetal cartilage tissue or dysplastic glomeruli and tubuli) in the presence of well-developed renal parenchyma. All specimens showed secondary pathologies such as renal-cortical atrophy, interstitial fibrosis, and interstitial-nephritis atrophy. The histologic evidence of well-differentiated renal parenchyma in concurrence with dysplastic parenchyma makes infravesical obstruction as the only cause of renal alterations in patients with PUV questionable. This coincides with the fact that organogenesis of the kidney is terminated at the 12th gestational week and secondary renal damage is irreversible at the 20th gestational week, but prenatal urinary diversion of the upper urinary tract is feasible in the 20th gestational week at the earliest. These facts must be taken into account when considering intrauterine urinary diversion.
American Journal of Perinatology Reports
Posterior urethral valve (PUV) is the most common congenital cause of bladder outflow obstruction in male neonates. We report a preterm neonate with PUV who presented as nonimmune fetal hydrops with intestinal obstruction in the antenatal period. The mother of our patient is a 33-year-old woman who started her prenatal care at our hospital at 30 weeks' gestation. Her sonogram done at 32 weeks in our hospital revealed fetal hydrops. It showed polyhydramnios, mild pyelectasis of right kidney, normal left kidney, and fetal ascites. Amniocentesis revealed bile stained amniotic fluid. Ultrasound during the procedure showed dilated fetal bowel loops with increased echoes. Following delivery at 32 weeks postnatal exam showed ascites with absence of skin edema, pleural, or pericardial effusion. The abdominal sonogram showed distended urinary bladder and bilateral hydroureteronephrosis. Bladder catheterization was done which relieved the bladder outlet obstruction. Voiding cystourethrogr...
Journal of Bangladesh College of Physicians and Surgeons/Journal of Bangladesh College of Physicians & Surgeons, 2024
Urinary ascites in a newborn infant is unusual and most commonly indicates a disruption to the integrity of urinary tract, the most common cause being posterior urethral valve. We report a case of fetal urinary bladder rupture due to posterior urethral valve. The case was diagnosed antenatally by ultrasonography and after birth the diagnosis is confirmed
BJU International, 2008
Purpose: Management of posterior urethral valves is significantly modified by the prenatal diagnosis. Our aim was to assess long-term outcome of children with prenatally detected posterior urethral valves treated at our institution by primary valve ablation without routine urinary drainage or diversion. Materials and Methods: A total of 79 cases of posterior urethral valves were detected prenatally at our hospital between 1987 and 2004. Of these cases 65 were managed postnatally, while pregnancy was terminated in 14. We studied the prenatal parameters of gestational age at diagnosis, renal parenchyma on ultrasound and amniotic fluid volume. Fetal urine was analyzed when indicated. Long-term outcome was assessed. Results: Primary valve ablation was done in all cases except 2. Median followup was 6.8 years (range 1 to 14.3). At the end of followup there were 11 cases of renal failure (17%) with 5 detected before 24 weeks of gestation, 6 cases of oligohydramnios and 9 cases of abnormal parenchyma. Gestational age at diagnosis and oligohydramnios were statistically significant predictors of final renal outcome (p ϭ 0.003 and p ϭ 0.02, respectively), while renal parenchymal changes were not (p ϭ 0.23). When fetal urinalysis detected good prognosis (12 cases) renal failure developed in none, compared to 2 of the 3 cases with a bad prognosis. Continence was achieved in 42 of 55 toilet trained children (76%), 3 had nocturnal enuresis and 10 (18%) were incontinent. Conclusions: Our long-term results of prenatally detected posterior urethral valves confirm that early valve ablation can be considered as the primary treatment in the majority of patients, without the need for preoperative drainage or diversion. Gestational age at diagnosis and volume of amniotic fluid are significant predictors of postnatal renal outcome.
Prenatal Diagnosis, 2016
ObjectiveThe objective of the study was to evaluate prenatal sonographic signs that distinguish male fetuses with posterior urethral valves (PUV) from those with vesicoureteral reflux (VUR).MethodsPrenatal data were retrospectively retrieved from all consecutive women delivering between 2003 and 2012 of a male newborn with a postnatal diagnosis of PUV or VUR. Prenatal parameters included fetal bladder characteristics, identification of a dilated posterior urethra, and change in shape and size in the fetal renal pelvis or ureter.ResultsOne hundred thirty‐six women gave birth to a male newborn with a postnatal diagnosis of PUV (n = 49) or VUR (n = 87). The presence of posterior urethral dilatation [21 (42.9%) fetuses versus 0 (0%), p = 0.000], a thickened fetal bladder wall [37 (75.5%) vs 4 (4.6%), p = 0.000], and anhydramnios [14 (28.6%) vs 0, p = 0.000] were strongly associated with the postnatal diagnosis of PUV. Change in shape and size in the fetal renal pelvis or ureter was obse...