Neurogenic bladder in twins: question

Excerpt

A 20-month-old boy was hospitalized at our institution with acute pyelonephritis. He had a history of two previous episodes of urinary tract infection (UTI) treated at an other center. Radiographic imaging and cystoscopy revealed no obstructive lesions such as posterior urethral valve (PUV), and dimercaptosuccinic acid (DMSA) scintigraphy was normal. Bilateral ureteral reimplantation was performed for repair of bilateral vesicoureteral reflux (VUR) when he was 12 months of age. He used antimicrobial prophylaxis irregularly during the follow-up period, and he had no constipation. Consanguinity was present between his parents. His weight, height, physical examination findings, and renal function tests were normal. Ultrasonography showed normal-sized kidneys with grade 4 hydronephrosis in the left side and dilatation in the left ureter and a mild hydronephrosis in the right kidney. The bladder wall was severely trabeculated with a thickness of 5 mm, and a DMSA scan revealed hypoactivity in the pelvic region of the left kidney without any cortical scars in either kidneys. Voiding cystourethrography (VCUG) showed grade 4 reflux on the left side and grade 3 reflux to the right kidney. …