Zia ul Miraj, Khan M R, Yusuf I, Rasool F, Ijaz Z.
Neonatal Urinary Ascites: An uncommon presentation of posterior urethral valves.
J Coll Physicians Surg Pak Jan ;9(2):112-4.

The authors report their experience with three neonates presenting with urinary ascites, an uncommon manifestation of obstructive uropathy secondary to posterior urethral valves. The age of patients ranged from one day to 28 days. Their main presenting features included abdominal distension, urinary tract infections and difficulty in voiding. The management involved pre-operative stabilization followed by a temporary vesicostomy. All patients made a satisfactory recovery as indicated by resolution of ascites, improvement of hydroureteronephrosis, and stabilization of renal functions. It is recommended that prompt decompression of the urinary tract by a temporary vesicostomy should be carried out prior to the definitive surgery, to maximise the potential for recoverability of renal functions.

CASE REPORT: B.S, a one-day-old full-term boy, with a birth weight of 3.0 kg was noticed to have gross abdominal distension since birth. He was delivered at home and no antenatal history was available. He passed meconium 6 hours after delivery but did not pass urine for 24 hours. Plain radiographs of the abdomen showed ground glass appearance, with `floating` bowel loops which were otherwise normal. Ultrasound scan (US) showed a thick-walled bladder, gross hydroureteronephrosis, bilateral perinephric collections and ascites. Blood examination revealed BUN: 1 mg/dl (normal range: 822 mg/dl), creatinine 1.0 mg/dl (normal range: 0.5-1.5 mg/dl), Sodium: 125 mEq/L (normal range 135-154 mEq/L),Potassium: 4.65 mEq/L (normal range: 3.5-5.4 mEq/L), Chloride: 96 mEq/L (normal range: 95-108 mEq/L) and Hb: 5.3 g/dl. Urine culture was positive for Pseudomonas. The patient was catheterised with a 6 Fr feeding tube. Intravenous fluids and antibiotics were commenced, and transfusion of packed cells was given. Micturating cystourethrogram (MCUG) showed bilateral vesicoureteric reflux (VUR) and features suggestive of PUV including a trabeculated urinary bladder and, elongated and grossly dilated posterior urethra. After 3 days of pre-operative stabilisation, he underwent a `Blocksom` vesicostomy. The baby made a gradual recovery and was discharged after 2 weeks. At a 3 month follow-up he was well and growing normally. Thereafter, he was lost to follow-up.

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