A male newborn has poor urinary stream and a palpable distended bladder. Renal ultrasound shows bilateral hydronephrosis with a dilated posterior urethra giving a keyhole appearance. What is the immediate next step in management?
- A Passage of a urethral catheter to drain the bladder ✓
- B Immediate surgical ablation of the valve
- C Bilateral percutaneous nephrostomy
- D Serum creatinine and micturating cystourethrogram before any intervention
Correct answer: A. Passage of a urethral catheter to drain the bladder
Explanation
Posterior urethral valves are the commonest cause of lower urinary tract obstruction in male infants. The first emergency step is bladder decompression with a fine urethral catheter, which relieves obstruction and allows renal function to be assessed before definitive endoscopic valve ablation. Nephrostomy is reserved for cases where catheterization fails or upper tract drainage is needed, and imaging must not delay decompression.
Reference: Bailey and Love's Short Practice of Surgery, 27th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.