A three years old boy presented with poor urinary stream. Most likely cause is:: (A) Stricture urethra, (B) Neurogenic bladder, (C) Urethral calculus, (D) Posterior urethral valve
Answer is D. POSTERIOR URETHRAL VALVE Symmetrical folds of urothelium extending distally from prostatic urethra to external urinary sphincter. - Exclusively an anomaly of male urethra. - Four types, Type 1 is MC (lies just distal to the verumontanum or at the verumontanum) ASSOCIATED WITH Oligohydramnios Renal parenchymal dysplasia (most impoant factor in overall prognosis) Abnormal bladder function (25%) Pulmonary hypoplasia (MC cause of death) INVESTIGATIONS Investigation of choice: MCU (shows proximal urethral dilatation with distal stricture) Cystoscopy Prenatal diagnosis by ultrasound(Keyhole sign on prenatal USG). MANAGEMENT First a small polyethylene feeding tube is inseed in the bladder and left for several days. Then fuher management is done according to serum creatinine level. - Normal serum creatinine - Transurethral ablation (endoscopic fulguration) of the valves - Increased serum creatinine and the worsening of condition - Vesicostomy (Blockson's technique is best) to bypass the obstruction.