International Urology and Nephroloyy 22 (2), pp. 1 2 9 - 1 3 2 (1990)

Bilaterally Dilated Upper Urinary Tract and Bladder Induced by Diabetes Insipidus Y. HIMENO,T. ISHIBE Department of Urology, Shimane Medical University, Japan (Received September 20, 1988) A case of hypothalamic diabetes insipidus accompanied by nonobstructive dilatation of the bladder and upper urinary tract is reported. Treatment with dDAVP resulted in decrease of the urine volume and improvement of dilatation of the urinary tract.

Diabetes insipidus is a disease characterized by inability to concentrate the urine, leading to polyuria and polydipsia. For the purpose to diagnose dilated urinary tract it is important to determine whether the upper urinary tract is dilated by obstruction of the lower urinary tract. Here a case of diabetes insipidus with dilatation of both the upper urinary tract and the bladder is reported in the respect of aetiology and diagnosis.

Case report A 28-year-old female with polydipsia and polyuria was admitted for the examination of dilated collecting systems. She had a history of heavy water drinking since childhood. There was no positive family history. Physical examination revealed short stature, with a blood pressure of 130/80 mm Hg and pulse rate of 80/min. On admission, urine volume ranged from 3 to 6 1/day. Serum creatinine was 0.8 mg/dl and urine osmolality was 50 mOsm/l. Complete blood cell counts, serum electrolytes, liver function tests and urinary sediments were within normal limits. Skull X-ray films and brain CT scans revealed no abnormality. Excretory urogram (DIP) showed marked dilatation of bilateral upper urinary tracts (Fig. 1) and voiding cystourethrography revealed a distended bladder (Fig. 2). There was no evidence of vesicoureteral reflux and urinary tract obstruction. Cystoscopic examination showed trabeculation of the bladder with normally positioned and shaped ureteral orifices. In a urodynamic study the bladder function was normoactive and normosensitive, and also bladder-sphincter coordination was good. Although urine osmolality prior to water deprivation was 53 mOsm/1 and did not increase after restriction for 9 hours, osmolality increased to 394 mOsm/1 after receiving 5 units of aqueous vasopressin intramuscularly. These results led VSP, Utrecht .4kad~miai Kiad6, Budapest

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Fig. 1. DIP: dilatation of bilateral pelvicalyceal systems and ureters

Fig. 2. Voiding cystourethrography: large bladder and no evidence of obstruction in the lower urinary tract International Urology and Nephrology 22, 1990

Himeno, Ishibe : Dilatation o f urinary tract

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Fig. 3. D I P taken one m o n t h after treatment: improvement of dilated pelviealyceal system and ureters

to the diagnosis of hypothalamic diabetes insipidus, and treatment was started with dDAVP in doses of 25 #g three times a day. After onset of treatment urine volume and water intake decreased. Followup DIP films one month after treatment tended to show resolution of the dilated urinary tracts (Fig. 3). Discussion

There are three types of diabetes insipidus: (1) hypothalamic, (2) nephrogenic and (3) psychogenic [1]. The diagnosis of these types can be made through a combination of water deprivation and vasopressin tests. On the other hand, concerning the aetiology it remains to be cleared whether dilatation of the urinary tract is actually caused by polyuria alone [2]. The urinary tract tends to dilate when it cannot transport over-produced urine for a long time [3, 4]. Another cause of large bladder with trabeculation may be an inhibition to void by voluntary contraction of the external sphincter [4]. In our case reported here there was no organic obstruction in the lower urinary tract and bladder-sphincter coordination was good. After treatment with dDAVP, improvement of the dilated urinary tract was obtained. So we concluded that dilatation of the upper urinary tract and bladder in this case was due to urine International Urology and Nephrology 22, 1990

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overproduction induced by hypothalamic diabetes insipidus. W h e n we diagnose dilatation o f the upper urinary tract, we must take into a c c o u n t that polyuria m a y be one o f the causes o f collecting system and bladder dilatations.

References 1. Shapiro, S. R., ~ Woerner, S., Adelman, R. D., Palmer, J. M.: Diabetes insipidus and hydronephrosis. J. UroL, 119, 715 (1973). 2. Manson, A. D., Yalowitz, P. A., Randall, R. V., Greene, L. F. : Dilatation of the urinary tract associated with pituitary and nephrogenic diabetes insipidus. J. UroL, 103, 327 (1970). 3. Carter, D. D., Goodmann, A. D.: Nephrogenic diabetes insipidus accompanied by massive dilatation of the kidneys, ureters and b/adder. J. Urol., 89, 366 (1963). 4. Boyd, S. D., Raz, S., Ehrlich, R. M.: Diabetes insipidus and nonobstructive dilation of urinary tract. Urology, 16, 266 (1980).

International Urology and Nephrology 22, 1990

Bilaterally dilated upper urinary tract and bladder induced by diabetes insipidus.

A case of hypothalamic diabetes insipidus accompanied by nonobstructive dilatation of the bladder and upper urinary tract is reported. Treatment with ...
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