title: Early diagnosis of the urofacial syndrome is essential to prevent irreversible renal failure.
abstract: BACKGROUND
  The urofacial or Ochoa syndrome is a rare disease characterized by the presence of functional obstructive uropathy associated with peculiar facial features when patients attempt to smile or laugh. Unfortunately, many of these patients remain without proper diagnosis or adequate treatment due to lack of recognition of the disease. This can ultimately result in upper tract deterioration and eventual renal failure. We present our experience with this rare syndrome.
  
  
  METHODS
  We identified 3 patients who presented initially with acute renal failure, urinary tract infection (UTI) and severe dysfunctional elimination. All patients were thoroughly evaluated, including screening for spinal cord anomalies, and were subsequently diagnosed with urofacial syndrome.
  
  
  RESULTS
  At the outset, the two older patients (aged 4 and 9 years) presented with the typical facial features when attempting to smile or laugh. One patient in the newborn period presented with urinary and fecal retention and septicemia and, to our knowledge, represents the youngest case of urofacial syndrome reported so far. All patients were evaluated with ultrasonography, renal scan, voiding cystourethrogram (VCUG) and urodynamics. Findings included hydronephrosis and a thick-walled, trabeculated bladder with poor compliance and detrusor hypereflexia respectively in each patient. All were subsequently treated with clean intermittent catheterization (CIC), antibiotic prophylaxis and anticholinergic therapy. One patient required appendicovesicostomy for CIC due to discomfort secondary to a sensate urethra.
  
  
  CONCLUSIONS
  Our series demonstrates that early recognition of this rare syndrome is necessary to adequately treat and prevent upper tract deterioration in these unique individuals. Although the urofacial is difficult to diagnose in infants, cognizance must be maintained in order to prevent severe subsequent sequalae.
authors.affiliation: Division of Urology, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada. nicanoramacedo@hotmail.com
authors.forename: Francisco A
authors.initials: FA
authors.lastname: Nicanor
authors.forename: Anthony
authors.initials: A
authors.lastname: Cook
authors.forename: Joao L
authors.initials: JL
authors.lastname: Pippi-Salle
mesh_terms: D002648:Child; D002675:Child, Preschool; D003950:Diagnostic Techniques, Urological; D042241:Early Diagnosis; D019066:Facies; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D008297:Male; D012904:Smiling; D013577:Syndrome; D014570:Urologic Diseases / Q000175:diagnosis* / Q000188:drug therapy / Q000601:surgery