Dr. Anil Takvani
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Dear All,
2 days old child from small village presented with poor urinary stream, lump in lower abdomen, dehydration, lethargy and fever.
No antenatal investigations/history.
Bladder palpable.
5f feeding tube inserted with little difficulty, this was followed by diuresis.
S. Creatinine: 2.3 mg%
S. Electrolytes: within normal limits.
Total white celks count: 18500, polymorphs: 90%.
Urine routine: 30 to 35 pus cells, culture awaited.
USG: bilateral gross HUN, bladder trabeculated, bladder neck hypertrophied and posterior urethra dilated.
He is put on 3rd generation cephalosporine. Under treatment of pediatrician for dehydration and sepsis.
He responded treatment. VCUG done on 5th day, attached for review.
Please discuss diagnosis and treatment
Comments(2)
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Dr. Anil Takvani
19 Jan 2021 07:05:36 PMThis patient underwent cystoscopy and valve fulguration before 5 years.
He is growing well. No episodes of UTI.Upper tract dilation improved but still there.S. Creatinine 0.4 mg%No day or night time incontinence.Recently two episodes of UTI. Culture positive, on AB prophylaxis.USG : bilateral HUN, PVR: 40ccHis recent VCUG done once he improved from UTI.Posting recent VCUG images.Will post his DMSA and serial USGs.Kindly discuss diagnosis and treatment.Thanks
Venugopal P
17 Jan 2021 09:59:50 AMDear All,
I could be miles apart from the diagnosis. At the first look of the VCUG, it can be labelled as PUV but is it?
If you look at the films provided carefully there is a shadow in shadow. This associated with the mention of difficulty in catheterization make me think whether we are dealing with a posterior Urethral Diverticulum. No doubt difficulty to catheterize can be present with PUV also.
Cystoscopic assessment will be able to differentiate the two on most occasions. But presence of folds as in PUV can also be observed in Posterior Urethral Diverticulum which could be the opening of the diverticulum.
I am sure Anil will enlighten us further as I do not thinks Anil would have posted this case unless there was a twist in diagnosis.
Venu