Abstract: Introduction: Posterior urethral valves (PUV) represent the most common cause of congenital lower urinary tract obstruction (LUTO) in male fetuses. Prenatal diagnosis is crucial for early prognostic evaluation and postnatal management planning. Pyelectasis and the "keyhole sign" are key sonographic features suggesting this anomaly.
Methods: We report the case of a male fetus diagnosed at 21 weeks of gestation with bilateral pyelectasis and signs of bladder outlet obstruction. Serial ultrasounds were performed, and postnatal confirmation was obtained via imaging and surgical intervention.
Results: Ultrasound at 21 weeks revealed bilateral renal pelvis dilatation, thickened bladder wall, and a keyhole sign. Follow-up showed mild oligohydramnios and increased renal echogenicity. Postnatal imaging confirmed PUV, and endoscopic valve ablation was successfully performed. Renal function stabilized with close follow-up.
Conclusion: This case underscores the importance of recognizing prenatal indicators of posterior urethral valves, such as pyelectasis and keyhole sign. Early detection enables appropriate counseling, neonatal preparation, and timely postnatal intervention to preserve renal function.
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