An antenatal scan finding of a dilated, thick-walled bladder that does not empty, combined with bilateral enlarged kidneys (bilateral hydronephrosis) and dilated ureters in a male fetus, is a pattern that should raise immediate suspicion of posterior urethral valves and should prompt specialist referral without delay. This is not a finding that should be monitored with repeated antenatal scans alone and reassessed only after birth: the earlier the diagnosis is confirmed and the clinical team is prepared, the better the outcome for the baby's kidneys. The steps that should follow this antenatal finding are: a detailed fetal anomaly scan by a specialist sonologist to characterise the urinary tract findings more precisely and to assess the volume of amniotic fluid, as oligohydramnios (reduced amniotic fluid) indicates that the kidney damage has already reduced fetal urine output significantly; a referral to a fetal medicine or paediatric surgery specialist for counselling and birth planning; planning for the delivery to take place at a hospital where a paediatric surgeon and neonatal team are available, or where postnatal transfer to such a hospital is immediately available; and pre-birth discussion with the family about what will happen in the first hours of the baby's life. In the delivery room, a urethral catheter will be placed in the baby immediately or in the first hours of life to drain the bladder and relieve the obstruction acutely. Investigation of the urinary tract and assessment of kidney function begins within the first day. The confirmation diagnostic procedure, the MCUG, is performed as soon as the baby is stable enough. The single most important message I give to parents receiving this antenatal finding is: seek a specialist paediatric surgical review now, plan the birth at or near a centre with paediatric surgical capability, and ensure the team is ready at delivery. The time between this scan and delivery is not waiting time. It is preparation time, and that preparation changes outcomes.
Related reading:
Posterior Urethral Valves in Male Newborns: What Parents Need to Know
Neonatal Surgery: A Complete Guide for Parents Facing a Newborn Surgical Diagnosis
Hirschsprung Disease in Newborns: What It Is, How It Is Diagnosed, and What Surgery Achieves
Congenital Anomalies in Newborns: Early Diagnosis and Pediatric Surgical Treatment Options
Written by Dr. Greeshma Suresh, MBBS, MS General Surgery, MCh Paediatric Surgery (Institute of Medical Sciences, Banaras Hindu University), Paediatric Surgeon, Vatsalya Children Hospital, Varanasi 221002. Phone: +91 9838585111.
