A 3-year-old boy presents with fever; dysuria and gross hematuria. Physical examination shows a prominent suprapubic area which is dull on pecussion. Urinalysis reveals red blood cells but no protein uria. Which of the following is the most likely diagnosis –

**Core Concept**
The clinical presentation of fever, dysuria, gross hematuria, and a prominent suprapubic area that is dull on percussion in a 3-year-old boy suggests a urinary tract obstruction or infection, specifically a condition that involves the bladder.

**Why the Correct Answer is Right**
The presence of red blood cells in the urine without proteinuria suggests a lower urinary tract source of bleeding, such as a bladder injury or infection. The suprapubic mass, which is dull on percussion, is consistent with a distended bladder. The most likely diagnosis is a urinary tract infection (UTI) complicated by a bladder stone or a congenital anomaly such as a posterior urethral valve.

**Why Each Wrong Option is Incorrect**
**Option A:** Pyelonephritis is an infection of the kidney, which may present with fever and dysuria but typically does not cause a suprapubic mass or gross hematuria.
**Option B:** A bladder tumor is rare in children and would not typically present with a suprapubic mass that is dull on percussion.
**Option C:** Urethral stricture is a narrowing of the urethra, which may cause obstructive symptoms but would not typically cause a suprapubic mass or gross hematuria.

**Clinical Pearl / High-Yield Fact**
In pediatric patients, a palpable suprapubic mass that is dull on percussion is highly suggestive of a distended bladder, which may be due to a urinary tract obstruction or infection.

**Correct Answer:** C. Posterior urethral valves.

✓ Correct Answer: C. Posterior urethral valves