Development of Renal Function After Neonatal Urinary Ascites Due to Obstructive Uropathy

Case Report: Neonatal Urinary Ascites Without Hydronephrosis: A Rare Case of Anterior Urethral Valve and Diverticulum in Preterm Newborn

The deformation of congenital obstruction of the anterior urethra is rare in male infants. The anterior urethral valve (AUV) and diverticulum are not common causes of distal urethral obstruction, which may be significant but difficult to diagnose in time. We describe a premature infant who was diagnosed with AUV as part of a diverticulum in the anterior urethra and was presented as massive urinary ascites without hydroureters and hydronephrosis. After indwelling abdominal tube and urinary catheterization, the infant's massive ascites were resolved, while urethral obstruction had successful treatment by Holmium laser. We suggest that the presence of urinary ascites in fetuses and neonates should be considered as a warning against urinary malformations.

Postnatal imaging of neonates with prenatally diagnosed genitourinary abnormalities: a practical approach

The advent of prenatal US and, more recently, fetal MRI has changed our pattern of referrals. In the current clinical algorithms, most neonates evaluated for genitourinary abnormalities are asymptomatic. These infants are referred for multidisciplinary consultation, imaging and surveillance. Evaluation of these children commences following pertinent review of available prenatal studies; this is appropriate, as in certain instances prenatally gathered information of potential prognostic significance can be inferred or can obviate the need for multiple examinations. US remains the first-line imaging modality for diagnosing urinary abnormalities in neonates and young infants, although it offers primarily morphological assessment. However, US coupled with MAG-3 scanning results in a powerful combination that provides anatomical and functional information. Recently, MRI and MR urography have been increasingly regarded as one-stop-shop examinations that can deliver both anatomical and functional information, and play an increasing role in the evaluation of ureteral ectopia and genital anomalies. Fluoroscopic examinations are reserved to exclude vesicoureteral reflux, to delineate urethral obstruction or to provide additional information to support a diagnosis. A practical approach to postnatal imaging of the neonate is discussed and the important genitourinary anomalies in this age group are presented and illustrated.

Single kidney and ureteral atresia in a newborn girl: a treatment concept

OBJECTIVE

To demonstrate a rare case of urological pathology, we report a combination of a single kidney and ureteral atresia. The treatment concept and outcome are outlined.

PATIENT AND METHOD

Antenatal ultrasound had revealed urinary ascites which lead to caesarean section in the 34th gestational week. Persisting anuria was confirmed postnatally and peritoneal dialysis started on the second day of life. Subsequent laparotomy revealed ureteral atresia after 3 cm of patent ureter. We created an ileum conduit after discussing various other therapeutic options.

RESULT AND CONCLUSION

A follow up of 12 months has shown steady function of the stoma with stable renal parameters. An ileal conduit represents a good option if high drainage is necessary in early childhood.

Life-threatening hyponatremia and acute renal failure due to iatrogenic neonatal bladder rupture

Neonatal urinary ascites is a rare entity, usually associated with a spontaneous rupture of the bladder with an underlying pathology such as high pressure or wall disruption. Its presentation involves abdominal distension, metabolic derangement and respiratory compromise. We report the case of a male neonate with solitary functioning kidney presented with life-threatening persistent hyponatremia and acute renal failure due to iatrogenic bladder rupture after catheterization. The aim of our report is to raise awareness on the possibility of bladder perforation in neonates even in the absence of technical faults. We discuss the uncommon presentation of our case and highlight the need for early recognition and management of urinary ascites, addressing all subspecialties involved in diagnostic or therapeutic procedures of neonates with urinary abnormalities.

[Impact of fetal urinary ascites on serum beta2 microglobuline in obstructive uropathies: a case report]

We report a posterior urethral valves case diagnosed at 33 week's gestation on a fetus presenting with anamnios and urinary ascites. In this fetus, the serum beta2 microglobuline rate was high, suggesting a very poor renal prognosis. At 1-year-old, the creatinine rate is nearly normal. In case of urinary ascites, the serum beta2 microglobuline rate could be improved in relation with the transperitoneal reabsorption of this protein.

Current diagnosis and management of fetal genitourinary abnormalities

Prenatal assessment with ultrasonography provides excellent imaging of fluid-filled structures (eg, hydronephrosis, renal cysts, and dilated bladder) and renal parenchyma. This information allows for the generation of a differential diagnosis, identification of associated anomalies, and assessment of the prenatal and postnatal risks of a given anomaly. This enhances parental education and prenatal and postnatal planning. This article discusses the current methods of diagnosis and management of fetal genitourinary anomalies, and also the postnatal evaluation and treatment of these conditions.

Urinary ascites without hydronephrosis in a neonate with urethral atresia

Urethral atresia is a rare and usually fatal cause of prenatal bladder outlet obstruction. We present a case of urethral atresia with urinary ascites to highlight the difficulties in making the diagnosis in the absence of hydronephrosis. We also discuss possible reasons why this patient maintained normal renal and pulmonary function.