Differential diagnosis, investigations and treatment:
Basic laboratory tests showed abnormal renal function with urea levels
at 60 g/dl and Creatinine levels at 2 g/dl. Full laboratory findings are
available in (Table 1)
Abdominal ultrasound confirmed ascites and revealed second-degree
hydronephrosis in the left kidney and first-degree hydronephrosis in the
right kidney. The diameter of ureter was increased bilaterally with
bilateral loss of corticomedullary differentiation. The bladder on
ultrasound appeared full and enlarged, filling most of the abdomen. Its
walls showed thickness and multiple diverticula along with a classified
polyp. These findings are consistent with neurogenic bladder and lower
urinary tract obstruction. MRI of the spine was performed to determine
the cause but no abnormalities were observed. MCUG confirmed bilateral
hydronephrosis with two large diverticula within the bladder wall
(Unfortunately unavailable). Renogram revealed a glomerular filtration
rate (GFR) of 40 ml/min for right kidney and 24 ml/min for left kidney
which is consistent with insidiously progressive chronic renal failure.
Initial management focused on protecting the kidneys from further damage
by performing ureterocutaneostomy as it was believed that patient had
neurogenic bladder.
After the surgery, urodynamics studies were conducted to rule out any
neurological bladder issues. However, these studies did not find any
evidence of a neurological bladder. As a result, the patient was
referred for a urethroscopy procedure.
During the urethroscopy, it was discovered that the patient had a
posterior urethral valve. The valve was treated by ablation during the
procedure. Subsequently, another urethroscopy was performed to assess
the condition of the urethra (video 1).