India (Commonwealth Union)_ A team of doctors at Apollo Hospital successfully treated a 10-day-old underweight newborn by performing surgery to remove a congenital posterior urethral valve (PVU) anomaly that was blocking the baby’s urinary passage. During a press conference, the doctors explained that the parents had already been informed about the presence of antenatal hydronephrosis (ANH) or fluid-filled enlargement of the kidneys in the fetus during a routine scan conducted at 20 weeks. However, no further instructions were provided at that time.
PVU is a condition in which blocking membranes develop in the urethra, impeding the normal passage of urine. Boy babies are more prone to this congenital defect. According to Dr. C. Alagappan, a senior consultant urologist and laparoscopic and transplant surgeon who headed the medical team during the surgery, this problem is considered very uncommon, affecting only one out of 50,000 newborns. However, in this particular case, it was the mother’s decision to undergo a scan on her own initiative due to a lack of fetal movements at seven months.
The ultrasound at seventh month revealed that the baby’s entire urinary tract was dilated and obstructed, and there was little amniotic fluid for the baby to float, indicating potential kidney and lung complications. Despite the medical professionals at Pudukottai Government Medical College and Hospital expecting the baby to be stillborn, the child, although severely underweight, weighing just over 1,000 grams, was delivered alive. Dr. Alagappan added, “The case was referred to us when the diagnosis of PVU was made, and the child had not passed urine for 48 hours”.
Following the surgery, Dr. Alagappan said, “We are pleased to see that the little boy has gained five times his birth weight, and his kidney functions, including urination, are normal. The baby’s health will be monitored for the long term to prevent any organ dysfunction”. He added, “Antenatal screening plays a crucial role in maternity healthcare. Therefore, parents should seek medical assistance when scans reveal potential birth defects.”
In a half-hour operation, the medical team adapted their tools to match the size of the infant and successfully removed the obstructive valve using laser technology. This surgical approach eliminated the need for the previously employed method of high urinary diversion, where urine is directed to exit from the flank skin. Urologist Nandhakumar, anesthetists Karthik and Azhagappan, as well as pediatricians P. Sivagurunathan and M. Divya, were all part of the medical team involved in the successful procedure.
