A pre-natal USG showed bilateral hydronephrosis in a male fetus. A repeat USG scan done few days later showed bilateral hydronephrosis with full bladder with reduced amniotic fluid. Emergency Caesarean Section was conducted. What is the FIRST likely investigation for the newborn?
Next Step: Diagnosis by demonstration of posterior urethral valves. Posterior urethral valves, the most common obstructive urethral lesions in infants and newborns, occur only in males and are found at the distal prostatic urethra. Demonstration of urethral valves on a voiding cystourethrogram establishes the diagnosis, as does endoscopic identification of valves. 2 possible answers for this question. a) Micturating Cystourethrogram b) Endoscopic identification of valve (in an emergency) In this question answer is Micturating Cystourethrogram. However, endoscopy is better because of severe obstruction indicated by b/l hydronephrosis and oligohydramnios. It can be clubbed with endoscopic destruction of the valve. Impoant: What does USG do? 1. Ultrasonography can be used to detect hydronephrosis, hydroureter, and bladder distension in children with severe azotemia. 2. It can also detect fetal hydronephrosis, which is typical of urethral valves, as early as 28 weeks of gestation - an enlarged bladder with bilateral hydroureteronephrosis is usually present in PUV. Treatment consists of destruction of the valves, but the approach depends on the degree of obstruction and the general health of the child. Treatment consists of destruction of the valves by endoscopic incision. In a premature infant with a small urethra prohibiting transurethral resection, a temporary cutaneous vesicostomy may be required to provide drainage and improve impaired kidney function. Ref: Cooper C.S., Joudi F.N., Williams R.D. (2010). Chapter 38. Urology. In G.M. Dohey (Ed), CURRENT Diagnosis & Treatment: Surgery, 13e.
Ultrasonography
Micturating Cystourethrogram
DMSA Scan
Renal Doppler