Congenital Anomalies

Question 1

Epispadius is associated with……, while hypospadius is associated with…..which is…..

Answer 1

Ectopia vesica
Chordee, ventral shortening & curvature

Question 2

List reasons for ttt hypospadius, …..is CI in this case

Answer 2

To allow the child to have normal stream of urine, straiten the bend of the shaft & allow normal sexual function, cosmetic appearance
Circumcision

Question 3

Mention techniques for correction of hypospadius & indication for each

Answer 3

MAGPI, glanular epi
Snodgrass tubularised incised plate urethroplasty, distal & midshaft

Question 4

Epispadius should be corrected during…..
Ttt for phimosis is…..

Answer 4

1st 7 yrs of life
Circumcision

Question 5

Describe CP of obstructive uropathy

Answer 5

Abdominal pain, hematuria, UTI, abdominal mass (hydronephrotic kidney or distended bladder)

Question 6

List causes of obstructive uropathy

Answer 6

PUJ obstr., UVJ obstr., posterior urethral valve, ureterocele, calculi

Question 7

…….is the most common operation performed to correct obstruction surgically

Answer 7

Dysmembered Anderson Hyenes pyeloplasty

Question 8

Most common cause of LUTI obstr. In males is….., its most life-threatening complication during fetal life is…..

Answer 8

PUV
Lung hypoplasia

Question 9

List findings of VCUG in PUV

Answer 9

1. Thickened trabeculated bladder wall
2. Dilated posterior urethra
3. Bladder diverticulae, VUR

Question 10

Describe emergency management of PUV in neonatal life

Answer 10

immediate catheterization to relieve obstruction, followed by cystoscopic ablation of PUV when baby is stable if resection of PUV is not possible, In severe cases with hugely dilated bladder and ureters temporary urinary diversion is indicated, in the form of Vesicostomy or even ureterostomy.

Question 11

List poor prognostic factors in PUV

Answer 11

Echogenic kidneys, elevated serum creat, delayed intervention, reflex nephropathy, proteinuria

Question 12

Mention a urological anomaly more common in females?
Then mention its complications

Answer 12

VUR
1. REPEATED UTI
2. Pyelonephritis
3. HTN
4. Progressive renal damage if bi ultimately renal failure

Question 13

1ry VUR is due to……, while 2ry is due to…..

Answer 13

Defect in functional flap-valve mechanism
Distal obstruction

Question 14

In VUR medical management is…..

Answer 14

Long term prophylactic Abx

Question 15

List relative indications of surgery in VUR

Answer 15

Grader 4 & 5 reflex
Medical noncompliance
Breakthrough UTIs
Continuous reflux despite medical ttt beyond 3 yrs
Lack of renal growth
Multiple drug allergies preclude use of Ab prophylaxis

Question 16

Mention absolute indications for surgery in VUR

Answer 16

1. Breakthrough pyelonephritis
2. Progressive renal scarring pt recieving Abx
3. Associated UVJ abnormality

Question 17

Mention surgical interventions in VUR

Answer 17

Endoscopic injection of bulking agent in intravesical ureter
Open or laparoscopic ureteric reimplantation

Question 18

List potential complications of ureteral reimplantation

Answer 18

Ureteral obstruction, injury to adjacent organs, recurrence of reflux