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Lee, Choi, and Oh: Nephrogenic Diabetes Insipidus Associated with Nonobstructive Dilation of the Urinary Tract and Voiding Difficulty
Original Article

Korean J Urol 2008;49(6):562-565.

Published online: 21 January 2008

DOI: https://doi.org/10.4111/kju.2008.49.6.562

Nephrogenic Diabetes Insipidus Associated with Nonobstructive Dilation of the Urinary Tract and Voiding Difficulty

Jeong Woo Lee, Hwang Choi, Seung-June Oh

Department of Urology, Seoul National University Hospital, Seoul, Korea

Received 14 April 2008       Accepted 2 May 2008

Copyright © 2008 The Korean Urological Association

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Nephrogenic diabetes insipidus (DI) is characterized by insensitivity of the distal nephron to vasopressin (ADH) and the inability to concentrate urine, which leads to excreting excessive quantities of urine. Upper tract dilation secondary to polyuria was previously shown to be associated with nephrogenic DI. We report here on 3 males with nephrogenic DI that caused voiding difficulty as well as massive nonobstructive dilation of the urinary tract.

Keywords: Diabetes insipidus, Voiding difficulty

REFERENCES

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Fig. 1.
Voiding cystourethrogram (A). The “christmas tree” appearance of the bladder was seen on ultrasonography (B). Severe hydronephrosis with dilation of the bladder and diatal ureter was seen.
kju-49-562f1.tif
Fig. 2.
(A) The uroflowmetry study revealed that the patient was voiding by abdominal straining. (B) The filling cystometrogram (CMG) shows a large bladder capacity with decreased sensation. (C) The voiding CMG demonstrates slightly weak detrusor contractility with abdominal straining.
kju-49-562f2.tif
Table 1.
Fluoroscopic urodynamic findings and the upper tract imaging study
    Case 1 Case 2 Case 3
Filling cystometry Bladder sensation ↓ ↓ ↓
Capacity (ml) ＞600 ＞450 ＞500
Involuntary detrusor contraction None Present None
Compliance Good Good Good
Voiding cystometry Urethral incompetency Detrusor contractility None ↓ None ↓ None ↓
Urethral relaxation Normal Normal Normal
UPP MUCP (cmH2O) 66 62 76
Fluoroscopic finding Trabeculation Severe Severe Moderate
VUR None None None
Upper tract obstruction None None None

UPP: urethral pressure profile, MUCP: maximum urethral closure pressure, VUR: vesicoureteral reflux

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