Posterior urethral valves

History: Newborn male infant with bilateral hydronephrosis detected in utero

Findings: Voiding cystourethrogram and postvoid KUB demonstrate ‘bullet nosed’ dilatation of the posterior urethra, a thick-walled trabeculated bladder, and severe vesicourethral reflux on the left.

Discussion: Posterior urethral valves are the most common cause of bilateral hydronephrosis in a male infant. Affected infants may present with maternal oligohydramnios, pulmonary hypoplasia, and cystic renal dysplasia. Vesicourethral reflux tends to be unilateral and may lead to forniceal rupture and urinary ascites. Older children or adolescents may present with urinary tract infections, voiding difficulty, or end-stage renal disease. Type 1 valves are the most common and extend from the verumontanum distally, leaving a small opening posteriorly for the passage of urine. Voiding cystourethrogram is the test of choice for diagnosis. Treatment frequently involves early urinary diversion and subsequent valve ablation.

Source: Aunt Minnie’s Atlas and imaging specific diagnosis (not images)

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