Severe bilateral hydroureteronephrosis from posterior urethral valves
Presentation
Poor urinary stream since birth, progressive abdominal swelling.
Patient Data
Both kidneys are markedly enlarged extending from the upper quadrants into the pelvis, displacing the liver and the spleen superiorly, the bowel loops anteriorly and superiorly. The right kidney measures (284 x 184 x 152 mm) while the left kidney measures (211 x 187 x 118 mm).
The pelvicalyceal systems are markedly dilated with absent remnant cortical tissue bilaterally.
The ureters are dilated and tortuous down to their insertions into the urinary bladder (RT-22 mm, LT-20 mm).
The urinary bladder is minimally distended with thickened wall (5 mm) and irregularities in its mucosa indicative of trabeculations. No filling defects seen within it.
The posterior urethra is dilated (17 mm) and elongated, suggesting a possible distal obstruction likely posterior urethral valve.
Case Discussion
Hydroureteronephrosis refers to abnormal dilatation of the pelvicalyceal systems and ureters. It results from distal urinary tract obstruction leading to back pressure build up. Common causes in pediatric age group include posterior urethral valve and neurogenic bladder. Other causes in older age group include ureteric stones, urethral stricture and benign prostatic hyperplasia. If the cause of obstruction is not relieved promptly, it may lead to impaired renal function.
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