Abstract

A 30 year old primiparous woman underwent routine 20w anomaly scan. Bilateral renal dilatation (10mm and 7mm) was found and the fetal genitalia appeared abnormal with a 4mm cyst at the tip of the penis. Differential diagnosis included phimosis and she was referred to the tertiary centre At 32 weeks the cyst was still present, the pelvices measured 22 and 23 mm and both ureters were dilated. Bladder and liquor volume were normal.

She underwent induction and ventouse delivery locally at 38 weeks.

The infant had a small cyst at the penis tip but also a swelling at the peno-scrotal junction. Renal function showed mild impairment and there was difficulty passing a urethral catheter. He started antibiotic prophylaxis and transferred to the neonatal surgical unit for catheterisation. Catheterisation resolved the penile cyst and cystoscopy revealed an anterior urethral diverticulum.

Endoscopic resection of this diverticulum was performed and the baby discharged with catheter in situ. This will be removed in the near future and an MCUG performed

Congenital anterior urethral “valves” have been described antenatally (1). They are diverticula of the urethra which fill with urine during voiding and may prolapse into the urethral lumen obstructing urinary flow. The aetiology is unknown.

The antenatal diagnosis facilitated a neonatal plan for this baby involving a multidisciplinary team and ensuring prompt treatment at birth. This case illustrates the importance of communication between secondary and tertiary care during the antenatal and postnatal period in the management of these cases.