Robert L. Lebowitz, M.D. Children' s Hospital, Harvard Medical School Boston, Massachusetts

This boy was found to have posterior urethral valves in utero and was treated with vesico-amniotic shunt. After delivery, he had fulguration of valves and developed a so-called valve bladder. He has left reflux. He is being treated with oral and intravesical ditropan. A recent ultrasound exam showed ditropan debris in the bladder (fig. 1) and in the ureter and pelvicalyceal system (fig. 2). There was also air in the pelvicalyceal system (fig. 3). The air and the ditropan granules could be seen flowing into the ureter and into the pelvicalyceal system in this boy who previously was shown to have reflux on a VCUG.