We had a 14- year -old boy presenting with on and off right sided flank pain and recurrent UTIs. His ultrasonography revealed grossly hydronephrotic right kidney with thinned out parenchyma.His renal function tests were normal.
Intravenous Pyelography showed Right Grossly dilated system with dilated tortuous and elongated ureter with delayed excretion.
DTPA scan was done for evaluation of renal function; it showed 15 % relative function on that side with delayed transit.
MCU ruled out the reflux but there was annular constriction at the post urethra suggestive of postrior urethral valve.
The patient was taken up for cystoscopy( with a paediatric scope) and we found annular Type 3 annular valve.This valve got disrupted with cystoscope. The bladder was appearing healthy.(in contrast to what we had imagined)
The patient was taken up for surgery as the kidney was decompensated with obstructive megaureter. The ureter was tapered on lateral side(Hendrens tapering) and with Paquins method the ureter was reimplanted. The bladder was not thickened making the obstructive mega-ureter to be of primary type.
Imaging and intra-operative photographs of the case are are shown.
The interesting point to note that primary obstructive megaureter co-existing with type 3 annular valve is a very rare event and posed dilemma for us.