sarika
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The mother of a newborn is concerned because he has not had a wet diaper during the first 24
hours of his life. The boy is the third child for this 26-year-old mother and 29-year-old father.
His siblings have no significant history. Prenatal care was appropriate and the mother says
that the infant's kidneys were "a little bit swollen" on prenatal ultrasound. There was no birth
trauma and no abnormalities were seen on initial examination at birth. Currently the infant
appears comfortable and there is no fever. Significant findings on physical examination include
a palpable mass in the suprapubic area, consistent with a distended bladder. The remainder of
the genitourinary examination is normal. Which of the following is the most appropriate next
step in the management of this infant?
A. Obtain a renal-bladder ultrasound
B. Order a retrograde urethrogram (RUG)
C. Perform voiding cystourethrogram (VCUG)
D. Place a urethral catheter to drain the bladder
E. Send the patient for surgery
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| vanshita
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A?
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| anjushree
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think it tobe A
WHAT IS THE ANSWER?
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| robin082006
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A
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| sarika
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answer is D
Unfortunately no explanation written in my QBANK but i think they are describing posterior urethral valve (kaplan surgery notes)
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| webjeee
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what causes the retention?
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| anjushree
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To dx -----retrograde uretherogram
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| webjeee
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Lower right: Posterior urethral valves. Marked dilatation and elongation of prostatic urethra (P), with reflux into prostatic ducts (straight arrow) secondary to posterior urethral valves (curved arrow) with bilateral vesicoureteral reflux into dilated ureters (U). Voiding cystourethrogram in a 10-day-old male.
So if to Dx, Voiding cystourethrogram is the choice, according to Current Surgery.
PS:The antegrade technique is required when lesions of the posterior urethra (for example, posterior urethral valves) are suspected; the retrograde technique is more useful for examining the anterior (penile) urethra.
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| doyoudig
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the reason u have to go for C Initially is b/c of the distended baldder, if you do not relieve the obstruction kidney damage will occur. After that u can go for VUCG which is only done after the acute illness of a UTI is resolved. Here it can be done right after as there is are no systemic sings such as fever....
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| doyoudig
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sorry I meant D initially then C
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| MAGY17
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POSTERIOR URETHRAL VALVES=NEWBORN BOY NOT TO URINATE DURING THE FIRST DAY OF LIFE
CATHETERIZATION TO EMPTY THE BLADDER
VOIDING CYSTOURETHROGRAM IS THE DX TEST
l AM AGREE WHIT ANS. C
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| sandra
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so its d rt?
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| cirus
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the ans is D
first u have to mange the distended bladder then investigate by VCUG
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