Jain Prashant, Prasad Ashish, Jain Sarika
Department of Paediatric Surgery and Paediatric Urology, BLK Superspeciality Hospital, Pusa Road, New Delhi, India.
Department of Radiodiagnosis, DODA Imaging, Pusa Road, New Delhi, India.
J Endourol Case Rep. 2020 Dec 29;6(4):362-365. doi: 10.1089/cren.2020.0138. eCollection 2020.
Multiple urethral anomalies are rare with its own challenges in diagnosis and management. The double urethral obstructions are often missed as proximal obstruction can mask the early diagnosis of distal obstruction. We present a rare case of concomitant posterior urethral valve (PUV) and anterior urethral valve (AUV) with a large anterior urethral diverticula (AUD) and hypospadias. An 11-month-old male child after fulguration of PUVs continued to have urinary symptoms. He was subsequently found to have distal urethral obstruction because of AUV and large anterior urethral bulbar diverticula. He also had associated glanular hypospadias. He was managed with endoscopic ablation of AUV and diverticulectomy. Concomitant PUV, AUV, AUD, and hypospadias is a rare occurrence. The diagnosis and management can be challenging in such cases with multiple anomalies. To avoid a misdiagnosis, a high index of suspicion, proper assessment of urethrogram, and detailed cystourethroscopy is required.
多种尿道异常较为罕见，在诊断和处理方面都有其自身的挑战。双尿道梗阻常常被漏诊，因为近端梗阻可能会掩盖远端梗阻的早期诊断。我们报告一例罕见病例，该病例同时存在后尿道瓣膜（PUV）和前尿道瓣膜（AUV），并伴有巨大的前尿道憩室（AUD）和尿道下裂。一名11个月大的男童在接受PUV电灼术后仍有泌尿系统症状。随后发现他因AUV和巨大的前尿道球部憩室而存在远端尿道梗阻。他还伴有阴茎头型尿道下裂。对其进行了AUV内镜下消融和憩室切除术治疗。PUV、AUV、AUD和尿道下裂同时存在的情况十分罕见。对于这种存在多种异常的病例，诊断和处理可能具有挑战性。为避免误诊，需要高度的怀疑指数、对尿道造影的恰当评估以及详细的膀胱尿道镜检查。
