congenital abnormalities of urinary tract. VUR

Question 1

what is VUR

Answer 1

ondition in which urine flows backward from the bladder to one or both ureters and sometimes to the kidneys

Question 2

types of VUR

Answer 2

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
-

Question 3

stages

Answer 3

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

Question 4

VUR dg

Answer 4

MCUG: determine stage

• passive: fill bladder w/ contrast
• active: durig voiding

US

blood test: creatine, urea, crp

urine culture

Question 5

VUR rx

Answer 5

abiotics

regular voiding

surger for grade 3 onwards

12 month follow up

Question 6

urinary tract obstruction

Answer 6

obstruction from urethra to KIDNEY

primary: genetic
secondary: trauma, tumor, calculus

Question 7

examples of urinary obbstrucion

Answer 7

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

Question 8

Posterior urethral valves

Answer 8

– 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!

Question 9

Obstructed urethra

Answer 9

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

Question 10

clinical presentation of urinary tract obrstruction

Answer 10

1. frequent UTI
2. signs of HYDRONEPHROSIS
3. symp of nephrolithiasis : pain . vom. hematuria

Question 11

what is

urinary tract stones

Answer 11

type of urinary obstruction d/2 calculus formation

boys> girls

Question 12

rf for urinary tract stones

Answer 12

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

Question 13

symp of urinary tract stones

Answer 13

acute pain radiating to sinwuinal regiono

haematuria

UTI symp

DYSURIA, FREQ, URGENCY

Question 14

dg of urinary tract stones

Answer 14

measure calcium, oxalate, uric acid lvls

US of ureters

ct

x ray

Question 15

rx of urinary tract stones

Answer 15

Antibiotics, drainage

Analgesics and intravenous hydration

Surgery – catheterisation with ureteroscopy & stone
extraction,

nephrolithotomy with/without lithotripsy

Question 16

what is Neurogenic bladder

Answer 16

` bladder dysfunction (flaccid or spastic) caused by neurologic damage

Question 17

etio of neurogenic bladder

Answer 17

Congenital anomaly

• Spina bifida (meningocele, myelomeningocele)
• spinal agenesis

Acquired

-Spinal trauma
-Tumour – sacrococcygeal teratoma, spinal cord
tumour,

Question 18

Neurogenic bladder

Clinical presentation

Answer 18

incontinence, UTI, obvious anatomic

defect

Question 19

Neurogenic bladder

Treatment

Answer 19

UTI prophylaxis, adequate urine drainage

Question 20

what is Enuresis

Answer 20

involuntary urination particularly at night usualy by children

Question 21

how often do newborns pass urine

Answer 21

15-20 times/24hrs.

Question 22

milestones required for bladder control

Answer 22

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

Question 23

causes of primary (never achieved night-time dryness)

nocturnal enuresis

Answer 23

Immature cortical mechanisms

Reduction in the nocturnal ADH levels

Deep night sleep

Question 24

what is secondary nocturnal enuresis

Answer 24

recurrence of bed wetting having been dry for a

few months

Question 25

rx of nocturnal enuresis

Answer 25

Restrict fluid intake before bed time

Getting up for active voiding after a few hours sleep

Enuresis electronic alarms

Desmopressin - ???

Tricyclic antidepressants - Imipramine

Question 26

causes of diurnal enuresis

Answer 26

Small bladder

Detrusor-sphincter dyssynergia

Wetting during laughter

Recurring cystitis

Neurogenic bladder

voiding every
10-15 min during emotional stress

vaginal voiding

Question 27

what is vaginal voiding

Answer 27

5-10 ml remain in vag avter voidinng d/2/ adhesion or fat girls voiding w/ legs together