Answer
1) Micturating Cystourethrogram X- ray.
2) Findings
a) There is present of suprapubic catheter of the right bladder to inject contrast dye.
b) The bladder is distended
c) Presence of irregular margin of bladder wall trabeculae
d) Diverticulum present.
3) Bladder obstructive uropathy secondary to meatal stenosis causing by Balanitis Xerotica Obliterens
4) Management
a) Insertion of Suprapubic catheter for temporarily relieves the acute presentation and creating the alterative pathway for urine output.
b) Renal function test to access the complication of this condition to renal.
c) Full blood count to look for evidence of ascending infection resulting from pooling of urine inside bladder.
d) Reconstructive surgery for meatal stenosis is the definitive treatment.
Notes:
Balanitis Xerotica Obliterens is a disease of unknown aetiology characterized by keratotic lesions with inflammatory changes leading to phimosis and occasionally meatal stenosis. It has the appearance of a white stenotic band at the end of the foreskin and minor trauma often results in haemorrhage [Oxford Pocket Handbook of Surgery]
A long standing meatal stenosis causing the accumulation of urine inside the bladder, causing it to distend. When the bladder distends for too long duration, it will stretch the bladder wall trabeculae causing an out pouching of it. The out pouching trabeculae may cause development of diverticulum.