1. DELAYED PRESENTING CASE OF EXTROPHY BLADDER WITH BILATERAL HYDROURETERONEPHROSIS AN UNUSUAL ASSOCIATION
Nitin Sharma*, Basant Chaurasia*, Mini Sharma**, Tarun Naik*, Sevak R Verma*
** Pt. JNM Medical college, Raipur, Chhattisgarh
*CM Hospital and Medical College, Nehrunagar, Bhilai, Chhattisgarh
Background
Bladder extrophy is an uncommon congenital anomaly of lower abdominal wall.
As the bladder is open there is usually no upper tract involvement in these cases.
Upper tract dilatation may be seen after successful bladder neck repair due to associated anatomical vesicoureteric reflux.
We are presenting an unusual association of bladder extrophy with bilateral upper tract involvement prior to bladder neck repair.
Figure 1. preoperative investigations
Figure 2. Surgical Correction using Bhatnagar’s procedure
Our Case
A 12 year old female child with an obvious extrophy baldder.
She had undergone an attempt of primary bladder closure without bladder neck repair at new-born period with dehiscence on the third day of surgery.
She had a history of recurrent bilateral flank pain since childhood.
She was investigated and worked up under pediatric medicine department and referred to us for surgical management
Surgical procedure
There was a small defect in the lower anterior abdominal wall with dense scarring through which the bladder plate was protruding.
There was an obvious kinking of both the ureters at this ring of fibrosis which was possibly causing the proximal dilatation.
As soon as the ring was released both the ureters could easily be cannulated with number 6 infant feeding tube.
The external opening of both the ureters in the bladder plate was wide.
Primary bladder closure with bladder neck repair on Bhatnagar’s principle was done.
Post-operative period was uneventful.
Post operative ultrasound scans shows mild hydronephrosis on both sides
Figure 3. preoperative CT Cystogram
Preoperative investigation
Figure 3. Postoperative status
Ultrasound: Revealed bilateral gross hydroureteronephrosis with AP diameter right 20mm and left 28mm.
IVP: Revealed bilateral hydroureteronephrosis with left side poorly functioning.
CT abdomen: Also revealed bilateral hydroureteronephrosis with no obvious cause.
Conclusions
Iatrogenic hydroureteronephrosis due to previous operative scar
Managed on routine principles
CONFLICT OF INTEREST: NONE DECLARED