Nephroblastoma in Pediatric Urinary Retention: A Rare Clinical Presentation in Sekadau General Hospital

Abstract

Introduction: Wilms’ tumor (WT) is the most common malignant renal neoplasm in children and classically presents as an asymptomatic abdominal mass in early childhood. Urological manifestations related to urinary tract obstruction are rare and may obscure the underlying diagnosis, particularly in older children and in settings where delayed presentation is common. Presentation of Case: A 7-year-old boy presented with acute urinary retention caused by extrusion of necrotic soft tissue through the urethral meatus. The patient had a four-month history of progressive abdominal distension without hematuria, trauma, or prior urinary instrumentation. Physical examination revealed a necrotic mass protruding from the urethra and a palpable left-sided abdominal mass. Emergency extraction of the obstructing tissue resulted in immediate relief of urinary retention; histopathological evaluation demonstrated necrotic material. Abdominal ultrasonography identified a solid left renal mass with associated pelvicalyceal system dilatation. The patient subsequently underwent radical nephrectomy. Histopathological examination of the nephrectomy specimen confirmed nephroblastoma with extensive tumor necrosis and capsular infiltration. The postoperative course was uneventful, with complete resolution of obstructive urinary symptoms, and the patient was commenced on risk-adapted adjuvant chemotherapy. Discussion: Urinary tract obstruction in Wilms’ tumor is most commonly associated with intrapelvic extension, while gross hematuria remains an uncommon feature. Necroturia resulting in acute urinary retention has not previously been reported as a presenting manifestation of WT. This extreme clinical phenotype likely reflects advanced intrapelvic tumor necrosis with migration of devitalized tissue into the urinary tract, underscoring the biological and anatomical heterogeneity of Wilms’ tumor. Conclusion: Wilms’ tumor may rarely present with necroturia and acute urinary retention. Recognition of such atypical presentations broadens the clinical spectrum of WT and highlights the importance of thorough abdominal examination in children presenting with unusual lower urinary tract symptoms.