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You are seeing a 4 year old boy with PMH of two UTIs and frequent episodes of otitis media. He has dysuria, frequency, straining to void, a poor urinary stream, and large volumes of urine when he does void. He is circumcised and his external genitalia exam is normal.
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December 9, 2020 at 12:49 am
B) Posterior urethral valves
Boys with posterior urethral valves, which are residual membranes in the posterior urethra that obstruct the flow of urine, are often diagnosed prenatally by ultrasound or in infancy due to recurrent UTIs. If not diagnosed in infancy, older boys may present as in the vignette. The PMH of frequent otitis medias may indicate that antibiotics were given for presumed OM during febrile illnesses that were actually UTIs. When UTIs occur in circumcised males work-up for an anatomic genitourinary problem should be done. Vesicoureteral reflux also presents with UTIs, but not with obstructive voiding problems. The external genital exam is normal, so phimosis and hypospadias are not present.