Contributed by
Nemours Children's Hospital, Orlando, Florida
Sukriti Chaudhri, Leida Maria, Jeniifer Kucera , and Koberlein George.
History
A male newborn presented with complex medical history including imperforate anus and multiple cysts in left kidney on prenatal imaging. He underwent colectomy and colostomy creation following pneumoperitoneum due to rectal perforation at D3 of life. The operative note also mentioned difficult intraoperative bladder catherteriization for which a urologist was called and he noticed a urethral pit above the meatus. Following the surgery, renal ultrasound and consecutively micturating cystourethrogram were obtained.
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Question
What are the findings seen in Voiding cystourethrogram and renal ultrasound?
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Correct answer
Urethral duplication with Left Multicystic dysplastic kidney (MCDK)
Discussion
Urethral duplications are rare congenital anomalies of the urinary tract with male preponderance. They consist of partial or complete development of an accessory urethra and may be associated with other urogenital abnormalities such as bladder exstrophy or bladder duplication. Duplications usually occur in sagittal plane and more dorsal copy is usually the duplicated tract. The Effman classification is the most used system to distinguish different types of urethral duplication. The primary imaging modalities for diagnosis include retrograde urethrography and voiding cystourethrography, as these can help to visualize the size, shape and position of two channels. Magnetic resonance imaging (MRI) can be useful in some cases for further characterization of the tracts, periurethral soft tissues and any associated genitourinary abnormalities.