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Neonate with urinary ascites but no hydronephrosis: unusual presentation of posterior urethral valves
  1. Elisabetta Prat1,
  2. Patricia Seo-Mayer2,
  3. Swati Agarwal3
  1. 1Pediatrics, Inova Children’s Hospital, Falls Church, Virginia, USA
  2. 2Pediatric Nephrology, Pediatric Specialists of Virginia, Fairfax, Virginia, USA
  3. 3Pediatric Critical Care, Inova Children’s Hospital, Falls Church, Virginia, USA
  1. Correspondence to Dr Swati Agarwal, swati.agarwal{at}


Posterior urethral valves (PUV) are an important cause of paediatric obstructive uropathy. PUV are usually diagnosed by prenatal ultrasonography (US) revealing hydronephrosis and bladder distention. We describe a 17-day-old male infant with abdominal distention who had no hydronephrosis on prenatal US. Laboratory investigations showed serum creatinine of 12 mg/dL, hyperkalaemia and metabolic acidosis. Abdominal US showed large amount of ascites, normal-sized kidneys without hydronephrosis and incompletely distended bladder. Paracentesis revealed clear, yellow ascitic fluid with creatinine level of 27 mg/dL compatible with urinary ascites. Voiding cystourethrogram (VCUG) demonstrated PUV with a dilated posterior urethra, grade 5 right vesicoureteral reflux and a ruptured kidney fornix with peritoneal extravasation of contrast. Foley decompression resulted in normalisation of creatinine within 72 hours. Transurethral resection of PUV was performed, and a repeat VCUG showed recovery of forniceal rupture. This case illustrates an unusual presentation of a potentially life-threatening but treatable cause of urinary tract obstruction.

  • congenital disorders
  • neonatal and paediatric intensive care
  • urology
  • renal medicine
  • neonatal health
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  • Contributors EP, PS-M and SA participated in clinical data collection and analysis, drafted the initial manuscript and approved the final manuscript as submitted.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent Parental/guardian consent obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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