To the Editor.—I was somewhat surprised that a diagnosis was not made prior to the age of 5 weeks in the "Radiological Case of the Month" that Dr. H. C. Faigel contributed to the American Journal of Diseases of Children (113:273 [Feb] 1967). A significant obstruction to outflow of urine from the bladder either by posterior urethral valves or bladder neck obstruction (if that exists) can be and should be made while the child is in the nursery. Although in Dr. Faigel's case the diagnosis was made at 5 weeks, it is possible that the child had already suffered irreversible renal damage.
The following techniques have been used by me to diagnose significant urinary outflow obstruction. Sometime during the child's stay in the newborn nursery, the child's urinary stream should be visualized and recorded in the chart. Visualization of the child's urinary stream by the nursery staff can