A newborn boy has a weak urinary stream, a palpably distended bladder, and bilateral flank masses. Ultrasound shows bilateral hydroureteronephrosis with a thick-walled bladder and oligohydramnios was noted antenatally. What is the most likely diagnosis?

• A Prune belly syndrome
• B Posterior urethral valves ✓
• C Bilateral multicystic dysplastic kidneys
• D Ureteropelvic junction obstruction

Explanation

Posterior urethral valves are the commonest cause of lower urinary tract obstruction in male infants, presenting with a poor or dribbling stream, distended palpable bladder, bilateral hydroureteronephrosis and antenatal oligohydramnios. Prune belly syndrome features absent abdominal musculature and cryptorchidism rather than a weak stream from obstruction. Bilateral MCDK is incompatible with survival when truly bilateral, and UPJ obstruction is upper tract and unilateral without bladder changes.

Reference: Nelson Textbook of Pediatrics, 21st ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.