Posterior urethral valves presenting as venous obstruction

Bauchner, Howard; Cranley, William R.; Vinci, Robert J.

doi:10.1016/0090-4295(91)80015-y

Urology

1991

DOI: 10.1016/0090-4295(91)80015-y

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Posterior urethral valves presenting as venous obstruction

Howard Bauchner¹,

William R. Cranley²,

Robert J. Vinci³

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2000

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“…There has been only a single case report of a child in whom the presence of posterior urethral valves resulted in bladder distention accompanied by venous and lymphatic obstruction that led to edema of the external genitalia and legs. 11 Scrotal edema in children is usually associated with acute epididymal and testicular disorders. The onset of scrotal swelling in this boy was not accompanied by pain and therefore probably did not result from any of the usual causes of acute edema of the scrotum or inguinal canal.…”

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confidence: 99%

Case 21-2000

Tracy¹,

F²

2000

N Engl J Med

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A 13-year-old boy was admitted to the hospital three years and eight months before the diagnostic procedure because of abdominal pain.Periumbilical pain had begun the day before the initial admission, after the patient had eaten cookies and an apple. He slept poorly that night, and by the next morning the pain had shifted to the right lower quadrant of the abdomen. During that day the temperature remained normal. In midafternoon he vomited 240 ml of red liquid after consuming a soft drink and was brought to this hospital. There was no history of fever, sweats, chills, nausea, vomiting, urinary frequency, dysuria, or hematuria.The temperature was 35°C, the pulse was 110, and the respirations were 18. The blood pressure was 110/60 mm Hg.Physical examination showed tenderness in the right lower abdominal quadrant, without signs of peritoneal irritation. The results of a rectal examination were normal. The external genitalia appeared normal. The urine was positive (+++) for ketones. Laboratory tests were performed (Tables 1 and 2). Abdominal radiographs revealed fecal debris in the colon. By the second hospital day, the pain had disappeared, and the findings on examination of the abdomen were normal. The patient was able to eat and was discharged home.Eight months later, his penis and scrotum became swollen. Treatment with antibiotics and corticosteroid ointment did not reduce the swelling. The patient returned to this hospital. He had no history of trauma, sexual contact, pain in the genital area, or travel to exotic areas, and there was no family history of lymphedema. Examination revealed soft, puffy swelling at the base of the penis, without evidence of inflammation. There was no edema of the legs. A retrograde urographic study with a voiding cystourethrogram showed slight narrowing of the urethral meatus without proximal dilatation, posterior urethral valves, and slight trabeculation of the bladder wall. No ureteral reflux was detected, and only a small residual volume of urine was present after voiding. Cystoscopic examination revealed narrowing of the urethral meatus and moderate trabeculation of the bladder. A small bladder diverticulum was excised, and urethral dilation and a meatotomy were performed.Examination two weeks later revealed increased edema in the area of the prepuce and the median raphe of the scrotum. Nonpurpuric cutaneous lesions were noted on the thighs. One month later, the edema was unchanged. A renal ultrasonographic study showed extensive soft-tissue swelling around the corpora cavernosum; the kidneys and bladder appeared normal. A computed tomographic (CT) scan of the abdo-*To convert the values for iron and iron-binding capacity to micromoles per liter, multiply by 0.1791.

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confidence: 99%

Case 21-2000

Tracy¹,

F²

2000

N Engl J Med

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Posterior urethral valves presenting as venous obstruction

Cited by 1 publication

References 8 publications

Case 21-2000

Case 21-2000

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