Fetal urinary ascites and spontaneous bladder rupture—A rare case of anterior urethral valves: A case report

Abstract

Fetal lower urinary tract obstruction (LUTO) affects 2.2 per 10,000 births. It can be a consequence of a range of pathological processes. It has a high mortality and morbidity. Ultrasound plays a pivotal role in the diagnosis of fetal obstructive uropathies, both pre and postnatally. In a study published in 2014, Dias et al. stated that prenatal ultrasound has a 95% sensitivity and 80% specificity in diagnosing LUTO. Posterior urethral valves (PUVs), ureterocele, bladder stone, bladder diverticulum, and meatal stenosis are common causes of urinary obstruction. Anterior urethral valves (AUVs) are a rare cause of congenital obstruction of the male urethra compared to the more commonly encountered PUV. AUV has a profound effect on the bladder, urethra, and upper urinary tract. It shares common prenatal sonographic features with other causes of LUTO. Sonographic features depend on the time of presentation and the severity of the obstruction. Antenatally, on ultrasound megacystis, hydronephrosis, and oligohydramnios may be seen. Postnatally, LUTO may result in severe renal dysfunction. In these cases, renal transplantation may be the only option to facilitate normal renal function. Rarely, extravasation of urine from the upper urinary tract, or rupture of the bladder may occur to relieve urinary pressure and prevent further renal damage. Spontaneous rupture of the fetal bladder in utero is a rare complication of LUTO. We present a case of late presentation of spontaneous bladder rupture in a 34-week 1-day-old male fetus with a postnatal diagnosis of AUV.