A 3-year-old boy presents with fever; dysuria and gross hematuria. Physical examination shows a prominent suprapubic area which is dull on pecussion. Urinalysis reveals red blood cells but no proteinuria. Which of the following is the most likely diagnosis?
Answer is 'c' i.e. Posterior Urethral Valve It is a case of Posterior Urethral Valve presenting with Urinary tract Infection.PUV is the most common cause of obstructive uropathy in a male child.The key to diagnosis are Age and sex of the patientUrinary tract infection is rare in male child , greater than one year old and less than 5 years old. Presence of urinary tract infection in this age group suggests , presence of some obstructive uropathy. ( posterior urethral valve in this case)Presence of Suprapubic dullnessPresence of suprapubic dullness suggests urinary retention, which is seen in this case due to obstruction caused due to posterior urethral valvesMore about Posterior Urethral Valves (PUV)These are symmetrical folds of urothelium extending distally from prostatic urethra to external urinary sphincter.It most commonly lies just distal to the verumontanum or at the verumontanum*It occurs only in males.It behaves as flap valves so, although urine does not flow normally a urethral catheter can be passed without difficulty.Sometimes, the valves are incomplete and the patient remains without symptoms until adolescence or adulthood.Approximately 30% of patients experience end stage renal diseaseVesicoureteral reflux occurs in 50% of patients.Diagnosis is made byvoiding cystourethrogram* &endoscopyBoth of these investigations clearly depict the site of obstruction.The diagnosis can be established prenatally by ultrasound.*ManagementFirst a small polyethylene feeding tube is inserted in the bladder and left for several days. Then further management is done according to serum creatinine level.with normal serum creatinine - transurethral ablation of the valve leaflets. *With increased serum creatinine and the worsening of condition - vesicostomy to bypass the obstruction and when normal creatinine levels are achieved, transurethral ablation is done.
Acute glomerulonephritis
Urinary tract infection
Posterior urethral valves
Teratoma
Urinary Tract