A Case of VURD Syndrome

ABSTRACT

VURD syndrome is a disorder characterized by a posterior urethral valve, unilateral reflux, and ipsilateral renal dysplasia. This syndrome is not uncommon, with an incidence in the range of 15 to 20% in patients with posterior urethral valve. Etiology is not clear, but there are a few reports that renal dysplasia is either a result of hydrostatic pressure transmitted to the developing kidney or a common teratogenic factor resulting in urethral obstruction, renal dysplasia, and vesicoureteral reflux. Infants with posterior urethral valves and persistent unilateral reflux after valve resection often have an associated nonfunctioning, dysplastic kidney. Misinterpretation of initial radiographic studies performed without coinciding bladder drainage results in a missed diagnosis of this syndrome and misguided surgical management. Functional assessment by a renal scan with bladder catheter drainage will avoid unnecessary staged or reconstructive procedures. Nephoureterectomy is recommended at about 1 year of age to improve voiding dynamics and to avoid infection. We experienced a case of VURD syndrome, first presenting bilateral hydronephrosis by ultrasonography during the prenatal period. Voiding cystourethrography revealed dilated posterior urethra and left vesicoureteral reflux, and DMSA scan showed a nonfunctioning left kidney.