Posterior urethral valve with bladder rupture and urinary ascites

Sivasamy Manohar, MD, DMRD


Case report

This is a case of a primigravida who came for the ultrasound examination at 35 weeks of gestation. The ultrasound examination showed urinary ascites with ruptured urinary bladder. The cause of the rupture was posterior urethral valve causing lower urinary tract obstruction.

Coronal view of the lower abdomen showed "keyhole" sign which is typical for the existence of the posterior urethral valve. Bladder wall was thickened due to previous extreme distention. There was a visible defect of the urinary bladder wall through which the urine leaked out into abdomen.

One of the kidneys showed mild hydronephrosis. The opposite kidney decompressed itself by rupture of the collecting system. The perinephric urinoma formed by urine draining into the retroperitoneal space.

The neonate died shortly after delivery.

Images 1,2: Images show the urinary bladder with a markedly thickened wall and a defect after a bladder rupture. Note ascites around the bladder.


Images 3,4: Image 3 shows a coronal view of the collapsed urinary bladder after bladder rupture with "keyhole" sign. Image 4 shows urinary ascites.


Images 5,6: Images show a fluid in the retroperitoneal area, urinoma, caused by accumulation of the urine due to rupture of the collecting system.


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