A male infant with bilateral upper urinary tract dilatation and recurrent infection: Question

Excerpt

A 60-day-old male infant was referred to our hospital with complaints of irritability and vomiting. He was born at the 32nd week of gestation, and antenatal ultrasound was not performed. During the neonatal period, he was hospitalized due to respiratory distress syndrome for about 15 days and then discharged. When he was 42 days old, he was admitted to the same hospital because of markedly decreased urine output in the previous 2 days. He had mild renal insufficiency, and renal ultrasonography showed bilateral upper urinary tract dilatation. He was referred to a paediatric surgery–urology centre with the presumed diagnosis of posterior urethral valve (PUV). Cystoscopy was performed and PUV was not detected, but trabeculation of the bladder was noted. After this procedure, Candida albicans grew in the urine culture and was successfully treated with fluconazole. After circumcision had been carried out, clean intermittent bladder catheterization (eight-times daily) was recommended, and re-evaluation of his condition was planned after 2 weeks. However, his mother could not usually perform clean intermittent bladder catheterization because she could not push the catheter easily and could not place it properly. Recurrent urinary tract infections occurred during that period. …