One-year-old male child presented with poor urinary stream since birth. The investigation of choice for evaluation is –
**Core Concept**
This question tests the evaluation and diagnosis of a congenital lower urinary tract obstruction. The patient's symptoms, poor urinary stream since birth, suggest a possible obstruction at the level of the bladder or urethra.
**Why the Correct Answer is Right**
The investigation of choice for evaluation in this case is ultrasound of the abdomen and pelvis. This is because ultrasound is a non-invasive and non-ionizing imaging modality that can provide valuable information about the size and structure of the bladder and urethra. It can also help identify any potential obstructions or abnormalities in the urinary tract, such as bladder outlet obstruction or urethral stenosis. Ultrasound is particularly useful in pediatric patients, as it does not require sedation or radiation exposure.
**Why Each Wrong Option is Incorrect**
**Option A:** Voiding cystourethrogram (VCUG) is not the first-line investigation for a child with suspected congenital lower urinary tract obstruction. While VCUG can provide valuable information about the bladder and urethra, it involves the instillation of contrast material into the bladder, which may not be necessary for initial evaluation.
**Option B:** Computed tomography (CT) scan is not typically used for the initial evaluation of a child with suspected congenital lower urinary tract obstruction. CT scans involve radiation exposure, which is a concern in pediatric patients.
**Option C:** Magnetic resonance imaging (MRI) is not the first-line investigation for this condition. While MRI can provide detailed images of the urinary tract, it is typically reserved for cases where ultrasound and other imaging modalities have failed to provide a clear diagnosis.
**Clinical Pearl / High-Yield Fact**
In pediatric patients, it's essential to consider the possibility of congenital lower urinary tract obstruction in the presence of symptoms such as a poor urinary stream or urinary retention. A prompt and accurate diagnosis is crucial to prevent long-term complications, such as bladder damage or kidney injury.
**Correct Answer: D. Ultrasound of the abdomen and pelvis. Ultrasound is a non-invasive and non-ionizing imaging modality that can provide valuable information about the size and structure of the bladder and urethra.