Neonatal Ascites and Urinary‐Tract Obstruction

Abstract

Summary A case is reported in which ascites and anuria due to unilateral ureteral stenosis and renal agenesia on the other side developed in a 14‐day‐old girl. After relief of the stenosis, the ascites disappeared, and one year after the operation the patient is alive and well.

Neonatal urinary ascites due to bladder perforation

“…A large group remains where no leak has been found: accumulation of ascites is often postulated to be due to transudation. S,', 14 The possibility of an alteration in adrenocortical activity has also been suggested. 20 The mortality of the condition is high, especially when the ascites presents in the first day of life."…”

“…Weller and Miller 11 further subdivided urinary ascites into three groups: those due to urethral valves alone; those with complex caudal anomalies including rectal and urethral atresias 2 , 5 , 12 ; and a third miscellaneous group due to a variety of causes. This includes ureterocele 13 , ureteric stenosis 14 , benign sacrococcygeal teratoma 15 , and neurogenic bladder due to myelomeningocele 16 or spinal cord compression due to a neuroblastoma 9 . The case described falls into this last category.…”

Urinary ascites complicating spina bifida.

“…The presence of urine in the ascitic fluid may be suspected from its urea content, which is greater than that of the plasma and confirmed by a micturating cystogram and intravenous pyelogram which, besides demonstrating the nature of the obstruction and its effect on the upper urinary tract, may reveal the site of the leak. Posterior urethral valves, which were present in 13 (probably 14) of the 19 cases reviewed by Cywes, Wynne, and Louw (1968), are the commonest cause of urinary ascites; other causes described are absence of muscle from the posterior bladder wall (France and Back, 1954), urethral atresia (Easton, 1960), a ureterocele producing a ball-valve obstruction of the urethra (North, Eldredge, and Talpey, 1966,) and ureteric stenosis (Linde, 1966). The bladder had been the source of leakage in only 3 published cases.…”

Unusual case of ascites secondary to unilateral distal ureteric obstruction in an infant

“…This condition is typically linked to diseases of the hepatobiliary, gastrointestinal, cardiac, metabolic diseases, infections, genitourinary disorders 1. Although the latter group is an uncommon cause of ascites,2 3 it can be a presenting feature in fetus or neonates with obstructive uropathy. Majority of the cases with obstructive uropathy commonly occurs at the level of ureteropelvic or ureterovesical junction or at the level of bladder outlet or level of urethra 4.…”