Reflux occurs after 800ml. So bladder capacity of 800ml in 28yr old is normal. Maximum bladder capacity of 1500ml and PVR of 450ml is due to reflux. As bladder has normal contractility and urethral resistance index, it is better to go for surgical intervention either deflux injection or ureteric reimplantation. Also one should work up to rule out neurogenic cause.

Thank you Shasanka Panda, In fact the presence of megacystis and bilateral hydroureteronephrosis, is due to the chronic polyuria, from diabetes insipidus he had since childhood, most of reviews recommend medical treatment for DI, and control of blood and urine electrolytes....etc

I may agree with you that deflux may improve hydroureteronephrosis but also polyuria due DI may worsen the condition more.

In our case the maximum vesical pressure is more than 40cm, which carries the risk of reflux , however decreasing this pressure should have a causal effect, which is difficult to achieve with such huge volume bladder....

I think that here we have a case with so-called 'diabetic bladder'. As conservative therapy I'd suggest to start with behavoural corrections, such as voiding by schedule at each three/four-hours and watchful waiting.

can you define ( Diabetic bladder), whether in general or based on urodynamic  characters?...of course timed voiding or evacuation with catheter is logical, but... still seems not enough in the face of the progressive hydronephrosis

This patient had a reduction of first desire, and an increased capacity. As you correcly said she had a huge bladder and hydronephrosys.

Personally I would like to investigate better:

1) the renal function by scintigraphy

2) the degree or the level of the reflux

3) the proper diagnostic work up of DI and its pharmacological management

4) the presence of urinary infections

I foresee:

1) behavioural therapy (bladder training)

2) clean intermittent catheterization or even a period with indwelling catheter... and periodical US for monitoring dilatation

3) if this doesn't work only surgery remains.... but with a lot of doubts about the possibility to control hydronephrosis... a second opinion of the endocrinologist is essential.

Let us updated, this is an intriguing and useful case.

Thank you  Luca Cindolo , actually this patient is under second opinion and evaluation by endocrinologist....I was thinking of antireflux with macroplastique injection, not surgical ...being less invasive

Of course, surgery is not always reimplantation... Deflux or Macroplastique or other bulking agents are the first choice for every grade of reflux.

Dear Dr. Saad Zaghloul, diabetic bladder is a kind of 'urological slang' for cystopathy caused by autonomic neuropathy seen in patients with diabetus mellitus. You can find a lot of publications on this topic. Here you can see full-texted one of them (open accessed) http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3153010/

Dear colleagues, I fully agree with your suggestions. But IMHO, the initial cause of the reflux and bilateral uretherohydronephrosis should be revealed and resolved at first. Without resolving the cause all of our therapeutic modalities will fail and we will observe recurrence. Anyway it is my own opinion and I am not trying to belittle the value of your suggestions.

Thank you Dr.Jakhongir, however our patient does not have diabetes mellitus, but insipidus which is totally different, his bladder is contracting well but with hugely large capacity, which is due to extra ordinary growth during childhood, due to polyuria...

it is functional dilation of the lower and upper urinary tract, to cope with the high volume of urine to decrease the number of urination.