KMID : 1218220120040020055
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Korean Journal of Pediatric Urology 2012 Volume.4 No. 2 p.55 ~ p.62
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Pre- and Post-Natal Management of Lower Urinary Tract Obstruction: a Case of Anterior and Posterior Urethral Valve
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Lim Bum-Jin
Song Sang-Hoon Kim Kun-Suk Park Sung-Chan
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Abstract
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A male newborn was delivered in our hospital at gestational age of 36+6 week due to premature rupture of membrane. He was diagnosed of bilateral hydronephrosis at fetal ultrasonography. At gestational age of 26+1 week, he underwent urine aspiration of left hydronephrotic kidney. At gestational age of 30+3 week, left urinoma-amniotic shunt was placed. After birth, urethral catheter was indwelled. At the second day after his birth, ultrasonography revealed diffuse and severe bladder wall thickening. Bilateral hydroureteronephrosis with multiple parenchymal cysts and increased parenchymal echogenicity was found. Fetal shunt tube was observed in the left pararenal space. After two weeks of his birth, he underwent urologic surgery. Under general anesthesia, cystourethroscopic examination revealed anterior urethral valve and partial posterior urethral valve. Bladder was severely trabeculated. Visual internal urethrotomy was performed for ablation of the anterior and posterior urethral valve. However, internal urethrotomy was considered not to be sufficient.
Vesicostomy was performed on lower abdomen of the neonate. Through the vesicostomy, bilateral ureteral catheters were inserted under guidance of retrograde pyelography. Retroperitoneally placed shunt was removed with incision of the flank skin. Two weeks later, ureteral catheters were changed to double-J internal stents. Serum creatinine level was normalized
from 3.56 mg/dl to 0.74 mg/dl after the procedure. After removal of the internal stents, hydronephrosis was not aggravated and the renal function was preserved during the follow up period of 4 months.
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KEYWORD
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Urethral obstruction, Vesicostomy
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