Posterior urethral valves with Downs syndrome presenting as scrotal urinary sinuses.

Posterior urethral valves (PUV) present with varying severity and grades of obstruction to the urinary tract. This unusual presentation of PUV as non healing scrotal sinuses after epididymo-orchitis has not been reported earlier. Association of PUV with Down’s syndrome is also rare though reported(1). Epididymo-orchitis is caused by retrograde flow of infected urine through the ejaculatory ducts. The mechanism of retrograde flow of urinary stream into the testes may be explained as follows. The severe A one and a half year old male was brought to us with bilateral anterior scrotal sinuses of one month duration (Fig. 1). The sinuses were draining clear urine. The child had earlier presented to another hospital with fever and bilateral inflamed scrotal swellings. This was thought to be a scrotal abscess and was drained. Initially it drained pus but subsequently scrotal sinuses were formed which drained clear urine intermittently. The child was dysmorphic and had features of Downs’ syndrome. He was well hydrated and the bladder was not palpable at the time of examination. The parents felt that the child had normal urinary stream. There was no history of antenatal oligohydramnios. Biochemical renal functions were normal. Ultrasound examination of the urinary tract did not reveal any abnormality. Micturating cysto-urethrogram showed a dilated posterior urethra suggestive of posterior urethral valves. Cystoscopy showed a hugely dilated posterior urethra. Large openings of the ejaculatory ducts were seen opening above the semilunar valves located below the Veru in the posterior urethra. Trans-urethral fulguration of valves was done at 5,7 and 12 O’clock position. The scrotal sinuses healed in a weeks’ time and the child is well and having good urinary stream Theophylline over dosage: acute single ingestion versus chronic repeated over medication. Am J Emerg Med 1985; 3: 386394.