Bilateral hydroureters and hydronephrosis in a neonate

A newborn boy was diagnosed antenatally with bilateral hydronephrosis. Postnatal renal ultrasound scan (USS) measured a renal pelvic anteroposterior diameter (APD) of 12 mm on the left side and 7 mm on the right side. The baby had good urine stream. Parents missed the repeat USS at the age of 1 week. An ultrasound done at 4 weeks revealed progressive hydronephrosis, bilateral hydroureters, with increased renal echogenicity. Normal bladder wall thickness was noted but two intravesical lesions were seen (figures 1 and 2). The APD was 13.5 and 11 mm on the left and right side, respectively. Figure 1 Renal ultrasound scan of (A) left kidney (LT) and (B) right kidney (RT) showing bilateral hydronephrosis (white arrows) and hydroureters (red arrow). Increased renal echogenicity is not shown in the figure. Figure 2 Showing normal bladder wall thickness but two intravesical lesions were seen (white arrows). Question How would you describe the intravesical lesions in figure 2? Bilateral ureteroceles Bilateral vesicoureteral reflux (VUR) Bilateral pelvi-ureteric junction obstruction Posterior urethral valves (PUVs) Which complication(s) may you expect in such cases? Urinary tract infection (UTI) Obstructive voiding symptoms Failure to thrive Ureteral calculus All of the above How would you treat this problem? Endoscopic puncture Deflux surgery Pyeloplasty Vesicostomy Answers are on page ▪▪▪