Carvell James, Mulik Roopa
Paediatric Department, Heartlands Hospital, Birmingham, UK
Paediatric Department, Heartlands Hospital, Birmingham, UK.
J Surg Case Rep. 2013 Feb 22;2013(2):rjt003. doi: 10.1093/jscr/rjt003.
This report outlines the case of a 3-year-old boy whose initial presentation was that of asymptomatic hypertension (lowest recording 148/90), found at preoperative check prior to stage 2-correction surgery for distal hypospadias. Upon diagnosis of true hypertension, an ultrasound of the child's renal tract showed evidence of marked hydronephrosis and calyceal dilatation. On the background of deteriorating renal function (Urea 25.5 and Creatinine 188), a Micturating Cystourethrogram was performed, demonstrating posterior urethral dilatation. With difficulties controlling blood pressure, the child was transferred to Urology care, where resection of a posterior urethral valve (PUV) was undertaken. Despite this, renal function deteriorated further and re-cystoscopy identified an anterior urethral valve (AUV), which was also resected. Renal function, although improved, remains poor and blood pressure is controlled with two anti-hypertensives. To the publisher's knowledge, the association between hypospadias, PUVs and AUVs is as yet undocumented.
本报告概述了一名3岁男孩的病例，其最初表现为无症状高血压（最低记录为148/90），在进行远端尿道下裂二期矫正手术前的术前检查中被发现。确诊为真性高血压后，对该患儿的肾脏进行超声检查，结果显示有明显肾积水和肾盏扩张。在肾功能恶化（尿素25.5，肌酐188）的情况下，进行了排尿性膀胱尿道造影，显示后尿道扩张。由于血压控制困难，该患儿被转至泌尿外科治疗，在那里进行了后尿道瓣膜（PUV）切除术。尽管如此，肾功能进一步恶化，再次膀胱镜检查发现了前尿道瓣膜（AUV），也将其切除。肾功能虽有所改善，但仍较差，血压通过两种抗高血压药物得以控制。据出版商所知，尿道下裂、后尿道瓣膜和前尿道瓣膜之间的关联尚未见文献记载。
