congenital abnormalities of urinary tract. VUR Flashcards
what is VUR
ondition in which urine flows backward from the bladder to one or both ureters and sometimes to the kidneys
types of VUR
primary
-incompetance of the valves aat the vesicoureteral junction
50% risk if mother has VUR
secondary -d/2 high pressure in the bladdeer -d/2 infection(CYSTITIS) -post op trauma -
stages
Grade I - Reflux into nondilated ureter
Grade II - Reflux into renal pelvis and calyces without dilation
Grade III - Reflux with mild to moderate dilation and minimal blunting of fornices
Grade IV - Reflux with moderate ureteral tortuosity and dilation of pelvis and calyces
Grade V - Reflux with gross dilation of ureter, pelvis, and calyces, loss of papillary impressions, and ureteral tortuosity
VUR dg
MCUG: determine stage
- passive: fill bladder w/ contrast
- active: durig voiding
US
blood test: creatine, urea, crp
urine culture
VUR rx
abiotics
regular voiding
surger for grade 3 onwards
12 month follow up
urinary tract obstruction
obstruction from urethra to KIDNEY
primary: genetic
secondary: trauma, tumor, calculus
examples of urinary obbstrucion
Hydrocalicosis
-dilatation of the calices as a result of
obstruction at the infundibulum
Fraley syndrome
-accessory artery which compresses the
lower pole of the kidney, mainly in boys
Ectopic ureter
Ureterocele
-cystic dilatation of the terminal ureter, mainly
in girls
-present as hydronephrosis, RVU, UTI
Megaureter
d/2/: VUR, OBSTRUCTION, after surgical correction of vur
Obstruction of the bladder neck
-ALWAYS sec to ectopuc uterocele/ calculosis/ PELVIC TUMOR
Posterior urethral valves – only in boys!
Urethral atresia– only boys!
Urethral hypoplasia– only boys! Bilateral hydronephrosis and
large bladder
Obstructed urethra
urinary tract stones
Posterior urethral valves
– only in boys!
Bilateral hydronephrosis with abnormally large bladder on ultrasound
Diagnosis – catheterisation and MCUG. Catheterisation is
difficult and may lead to severe bladder spasm. Urine leaks
around the catheter. Do not use balloon catheter!
Obstructed urethra
In boys – always secondary due to catheterisation,
trauma, surgery –presents as poor urinary flow, dysuria,
haematuria
In girls – extremely rare, the location of the urethra
protects it from trauma
clinical presentation of urinary tract obrstruction
- frequent UTI
- signs of HYDRONEPHROSIS
- symp of nephrolithiasis : pain . vom. hematuria
what is
urinary tract stones
type of urinary obstruction d/2 calculus formation
boys> girls
rf for urinary tract stones
Increased urine concentration of stone-forming
substances
Presence of chemical or physical factors that facilitate
stone formation
- Increased concentration of calcium in the urine
-Increased uric acid
-High oxalate concentration
-
Insufficient amount of inhibiting factors – magnesium,
citrate
Small amount of urine
symp of urinary tract stones
acute pain radiating to sinwuinal regiono
haematuria
UTI symp
DYSURIA, FREQ, URGENCY
dg of urinary tract stones
measure calcium, oxalate, uric acid lvls
US of ureters
ct
x ray
rx of urinary tract stones
Antibiotics, drainage
Analgesics and intravenous hydration
Surgery – catheterisation with ureteroscopy & stone
extraction,
nephrolithotomy with/without lithotripsy
what is Neurogenic bladder
` bladder dysfunction (flaccid or spastic) caused by neurologic damage
etio of neurogenic bladder
Congenital anomaly
- Spina bifida (meningocele, myelomeningocele)
- spinal agenesis
Acquired
-Spinal trauma
-Tumour – sacrococcygeal teratoma, spinal cord
tumour,
Neurogenic bladder
Clinical presentation
incontinence, UTI, obvious anatomic
defect
Neurogenic bladder
Treatment
UTI prophylaxis, adequate urine drainage
what is Enuresis
involuntary urination particularly at night usualy by children
how often do newborns pass urine
15-20 times/24hrs.
milestones required for bladder control
Sensation for a full bladder
Brain development – suprapontine modulation
Ability for active constriction of the external sphincter
Normally increasing bladder volume
The child needs to be motivated to stay dry
causes of primary (never achieved night-time dryness)
nocturnal enuresis
Immature cortical mechanisms
Reduction in the nocturnal ADH levels
Deep night sleep
what is secondary nocturnal enuresis
recurrence of bed wetting having been dry for a
few months
rx of nocturnal enuresis
Restrict fluid intake before bed time
Getting up for active voiding after a few hours sleep
Enuresis electronic alarms
Desmopressin - ???
Tricyclic antidepressants - Imipramine
causes of diurnal enuresis
Small bladder
Detrusor-sphincter dyssynergia
Wetting during laughter
Recurring cystitis
Neurogenic bladder
voiding every
10-15 min during emotional stress
vaginal voiding
what is vaginal voiding
5-10 ml remain in vag avter voidinng d/2/ adhesion or fat girls voiding w/ legs together
