A unique presentation, and management, of acute urinary retention in a young boy with underlying vesicoureteral reflux
A 7-year-old boy who had no relevant past medical history (UTIs or other) presented with acute urinary retention. He was systemically well but had mild suprapubic discomfort and a palpable bladder. Examination of the penile shaft revealed a palpable hard swelling. The urethral meatus was patent. Following failure of conservative management of urinary retention (placing the boy in a warm-bath, adequate analgesia), a cysto-urethroscopy was performed under general anaesthetic. Due to lack of paediatric instruments on site, a 6.6-Fr adult ureteroscope was used. This revealed an obstructing urethral calculus impacted in the navicular fossa. The stone was fragmented using a HoYag laser and extracted. Cystoscopy with the same instrument then revealed multiple bladder calculi with a patulous right ureteric orifice. These stones were washed out and the patient was catheterized (6-Fr urethral catheter). Serum calcium, urate and renal function were normal. Post-operative ultrasound revealed a small, scarred right kidney and large (hypertrophied) left kidney. Micturating cystourethrogram demonstrated grade 1 and 2 VUR in the right and left ureters, respectively, and an opacification in the upper right ureter suspicious of a calculus. CT KUB confirmed a 4 cm (cranio-caudal) by 0.8cm (transverse) right ureteric calculus (Fig. ). DMSA scan revealed 4% (right) split renal function. The patient subsequently underwent a right laparoscopic nephroureterectomy (Fig. ).