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Add as FriendPosterior Urethral Valve-Urinary tract infection

by: Mofazzol

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1 : WELCOME TO CLINICAL CASE PRESENTATION
2 :
3 : Name: Mahir Age:25d. Adress:Baitul Aman, Adabor, Dhaka PATIENT PARTICULARS
4 : HOSPITAL PARTICULARS Date of Admission: 01.11.06 Ward no: Cabin Bed no: 407 Reg. no: 8468/10
5 : Presenting complaints # Dribbling of urine since birth
6 : Presenting history Presenting complaints started since birth The patient was born by LUCS at term. Did not voided for 36 hrs. Later the father noticed the neonate strains and cries during voiding. Though the stream of urine appeared normal but the patient dribbled after each act of micturition. On third day of his life the patient developed retention of urine and abdominal distension, for which he was admitted in Japan –Bangladesh Hospital and was treated conservatively with catheterization. Later the patient was ref. to DSH for better management.
7 : History cont….. # No fetal urinary problem was detected during antenatal sonography. # No history of fever. # No haematuria # Abdominal distension was not associated with vomiting or bowel abnormality.
8 : GENERAL EXAMINATION Restless. Weight – 3.8 kg No pallor, Cyanosis Oedema, dehydration Neck vein Neck glands – not palpable Pulse – 130/m Resp – 40/m Temp – 980F
9 : ABDOMINAL EXAMINATION Distended, more marked over suprapubic region.. No visible peristalsis. Kidneys were not palpable and ballotable urinary bladder was full.
10 : ABDOMINAL EXAMINATION Liver, Spleen was not palpable. No other organomegaly. Hernial orifices were intact. External genitalia including ex. Urethral meatus was normal.
11 : Other Systemic Examination Normal.
12 : SALIENT FEATURE The patient presented with straining and cry during each act of micturition since birth. The patient dribbled after voiding. On third day of his life the patient developed retention of urine and abdominal distension, for which he was treated conservatively with catheterization.
13 : Distended, more marked over suprapubic region.. No visible peristalsis. Kidneys were not palpable and ballotable urinary bladder was full. External genitalia including ex. Urethral meatus was normal. SALIENT FEATURE
14 : POSTERIOR URETHRAL VALVE Provisional Diagnosis
15 : . URINARY BLADDER DIVERTICULAM. Differential Diagnosis:
16 : INVESTIGATIONS USG ; RIGHT SIDED HYDRONEPHROSIS HYDROURETER.RIGHT URETER INSERTER POSTERIO _INFERIOR ASPECT OF UB INTO A SACCULAR DILATATION RESEMBLING VESICAL DIVERTICULUM. MILD PELVICALYCEAL DILATATION ON LEFT SIDE.
17 : INVESTIGATION DONE I.V.U. PILOT FILM
18 : HYDRONEPHROTIC CHANGE
19 : NORMAL POSTERIOR URETHRA
20 : HIGH GRADE VUR RT
21 : Hb% - 12.5gm% TC DC - within normal limits Serum electrolytes –Na 142 mmol/l k 4.6 mmol/l Cl 104 mmol/l Blood Urea - 2.4 mg/l Serum creatinine –60umol/l INVESTIGATIONS
22 : OPERATIVE MANAGEMENT Date of operation : 04.11. 06 Indication : Urinary bladder diverticulum with grade 4 VUR on right side . Incision : Right lower transverse Finding : A large Urinary bladder diverticulum was found on the right side. Right ureter opened into the diverticulum.
23 : Operative procedure . Diverticulectomy and closure of UB in two layers. Right sided ureterostomy.
24 : PAST OPERATIVE PERIOD Ureterostomy functioning. No features of urosepsis. Blood urea ,Serum creatinine ,Serum Electrolytes are normal.
25 : URETEROSTOMY
26 : Further plan Ureteric reimplantation on right side.
27 : THANK YOU

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