A 3-year-old boy presents with fever; dysuria and gross hematuria. Physical examination shows a prominent suprapubic area which is dull on percussion. Urinalysis reveals red blood cells but no proteinuria. Which of the following is the most likely diagnosis?
Correct Answer: Posterior urethral valves
Description: Posterior urethral valves,the most common obstructive urethral lesions in infants and newborns, occur only in males and are found at the distal prostatic urethra. The valves are mucosal folds that look like thin membranes; they may cause varying degrees of obstruction when the child attempts to void. Children with posterior urethral valves may present with mild, moderate, or severe symptoms of obstruction. Urinary infection and sepsis occur frequently. Severe obstruction may cause hydronephrosis, which is apparent as a palpable abdominal mass. A palpable midline mass in the lower abdomen is typical of a distended bladder. Voiding cystourethrography is the best radiographic study available to establish the diagnosis of posterior urethral valves. Treatment consists of destruction of the valves. Ref: McAninch J.W. (2008). Chapter 40. Disorders of the Penis & Male Urethra. In E.A. Tanagho, J.W. McAninch (Eds), Smith's General Urology, 17e.
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