Occult ureteropelvic junction obstruction presenting as anuria and urinary ascites in an infant with antenatal, unilateral hydronephrosis

Abstract Objective To discuss an unusual case of occult ureteropelvic junction obstruction. Case A premature male infant with severe, unilateral hydronephrosis presented to the emergency room with 20 h of dry diapers. Placement of urethral catheter did not return urine. Imaging revealed persistent h...

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Bibliographic Details
Published in:Journal of pediatric urology 2009-10, Vol.5 (5), p.405-407
Main Authors: Hirselj, Daniel A, Zmaj, Paul M, Firlit, Casimir F
Format: Article
Language:English
Subjects:
Anuria - etiology
Anuria - surgery
Ascites - etiology
Ascites - surgery
Fetal Diseases
Humans
Hydronephrosis
Hydronephrosis - complications
Hydronephrosis - surgery
Infant, Newborn
Infant, Premature, Diseases - surgery
Kidney Pelvis
Male
Obstruction
Pediatrics
Ureteral Obstruction - complications
Ureteral Obstruction - surgery
Urinary ascites
Urine
Urology
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Summary:Abstract Objective To discuss an unusual case of occult ureteropelvic junction obstruction. Case A premature male infant with severe, unilateral hydronephrosis presented to the emergency room with 20 h of dry diapers. Placement of urethral catheter did not return urine. Imaging revealed persistent hydronephrosis on the previously affected side and new-onset hydronephrosis with perirenal fluid on the contralateral side. Patient was taken to the operating room and forniceal rupture from occult ureteropelvic junction obstruction with urinary ascites was identified. The obstruction was surgically repaired at that time and his postoperative course was uncomplicated. Discussion While most agree on postnatal evaluation for some children with antenatal hydronephrosis, there is no consensus as to the timing and frequency of evaluation. The risk of significant obstruction in children with low grades of hydronephrosis is very low, and many are not followed. This is a rare case in which low-grade postnatal hydronephrosis resulted in significant clinical obstruction.
ISSN:1477-5131
1873-4898
DOI:10.1016/j.jpurol.2009.03.016