A male neonate presents with a palpably distended bladder, weak urinary stream and bilateral flank masses. Ultrasound shows bilateral hydronephrosis and a thick-walled bladder. Micturating cystourethrogram shows a dilated posterior urethra with a sharp transition at the level of the verumontanum. After catheterisation stabilises the infant, what is the definitive treatment?
- A Vesicostomy as permanent diversion
- B Transurethral fulguration of the valves ✓
- C Open suprapubic cystostomy
- D Bilateral cutaneous ureterostomy
Correct answer: B. Transurethral fulguration of the valves
Explanation
Posterior urethral valves are the commonest cause of lower urinary tract obstruction in male infants. Type I valves arise from the caudal plicae colliculi and cause a dilated prostatic urethra with a abrupt calibre change on MCU. Initial bladder catheterisation decompresses the system, followed by endoscopic transurethral valve ablation, which is curative in most cases. Cutaneous vesicostomy or ureterostomy is reserved only when ablation fails or the infant is too small for cystoscopy.
Reference: Campbell-Walsh-Wein Urology, 12th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.