Neurogenic bladder and bilateral sever dilated ureter

Nasser Simforoosh - Ali Mohammad Mirjalili

Case Presentation

The patient is a 7 year old girl presented by recurrent urinary tract infection (UTI) under prophylactic antibiotic therapy. She had undergone repair of imperforated annus and colostomy diversion at the first days of birth and revision of this diversion was performed at three months of age. Because of bilateral high grade vesicoureteral reflux and febrile UTI, she underwent anti reflux surgery by Gilvernet technique. After two years, due to failure to thrive, recurrent UTI and enuresis, two times bulking agent and Botox injection into the bladder were performed. Regardless to the aforementioned procedures, anticholinergic (oxyboutinin) and baclofen consumption and intermittent catheterization, she had positive urinary culture and imaging studies confirmed constant bilateral hydroureteronephrosis.

 

VCUG

High grade vesicoureteral reflux in left side and low grade in right side.

 

IVP

Bilateral moderate to sever hydroureteronephrosis

 

MRU

 

DMSA SCAN

Right kidney: non function

Left kidney: sever decreased function

 

Cystoscopy

Sever trabeculation with multiple diverticula and succula in the bladder and ureteral orifice in both sides were dilated and in lateral position. The ureters were severly dilated that we can enter to them with cystoscope.

 

Surgical procedure

The patient underwent ureterocystoplasty.

 

Edited By: Ali Mohammad Mirjalili

           (Apr - 2009)

	Submission: 4/25/2009, Modified: 5/28/2009