FERGU anatomy

Question 1

Pain sensation in bladder

Answer 1

due to spasm/distention - mostly parasympathetic (ant. abdominal wall, perineum, genitals)

Question 2

Cystocele

Answer 2

loss of bladder support due to damage to perineal muscles
herniation of bladder into vaginal wall
can occur due to damage from childbirth

Question 3

Ectopic vesicae

Answer 3

absence of anterior abdominal wall, pubic bones, and anterior wall of urinary bladder results in trigone & openings of ureters being visible

Question 4

Prostatic urethra

Answer 4

3-4 cm
widest
midline ridge = urethral crest, bordered by urethral sinuses - ducts of prostate drain into these sinuses
seminal colliculus - ejaculatory duct drains here

Question 5

Pudendal artery

Answer 5

off of internal iliac

Question 6

Pronephros

Answer 6

1st 6 cervical somites
a few tubules –> induce formation of pronephric duct
grows down through thorax/abdomen, becomes mesonephric duct

Question 7

Mesonephros

Answer 7

functional in first trimester
~ 70 tubules/side
grows down on each side to the cloaca = vas deferens
some from mesonephric kidney becomes rete testis

Question 8

Metanephros

Answer 8

5th week

Uretic bud grows posteriorly from mesonephric duct into surrounding mesoderm

Question 9

Polycystic kidney disease

Answer 9

failure of tubules to fuse with CDs

Question 10

paramesonephric ducts

Answer 10

Mullerian ducts, appear as Wolffian ducts disappear

Question 11

Bladder

Answer 11

develops from urogenital sinus + allantois
Allantois connected with umbilicus - becomes ligament
mesoderm covered by endoderm

Question 12

Renal agenesis

Answer 12

absent kidney development
can occur due to abnormal Wolffian duct, ureteric bud or metanephric mesenchyme
true agenesis = ipsilateral ureter and hemitrigone also absent
Contralateral kidney undergoes compensatory hypertrophy
common - missing ipsilateral vas deferens, Mullerian duct problems
15% have vesicourethral reflux (VUR)

Question 13

Duplication anomalies

Answer 13

of ureters due to abnormal ureteric bud
can cause ureterocele = bag-like dilation of ureter, can cause obstruction
UTI, pain, VUR

Question 14

Horseshoe kidney

Answer 14

fusion anomaly
metanephric mesenchyme not separated during development
can be associated with UPJ
often gets hooked on inferior mesenteric artery

Question 15

Testicular descent

Answer 15

2nd month
migrates and sits at internal inguinal ring - 4th month
into scrotum - 7th month
cryptorchidism = undescended testicle

Question 16

Male/female differentiation

Answer 16

week 9

Question 17

Male developing factor

Answer 17

SRY gene on Y chromosome
testes produce: androgens & Mullerian inhibiting factor
navicular fossa = glans of penis caniculation

Question 18

UPJ

Answer 18

ureteropelvic junction
abnormal vessel development
leads to hydronephrosis
Tx: surgical repair
laproscopic, endo-urological, open urological

Question 19

Posterior urethral valves

Answer 19

membranous fold in posterior urethra –> obstruction
affects kidney & lungs
only seen in male

Question 20

VUR

Answer 20

abnormal intravesical ureter that is too short, due to abnormal ureteric bud
pyelonephritis, renal dysplasia and damage
most common lower Urinary tract congenital anomaly
Dx: voiding cystourethrogram
Tx: surgical repair (endoscopic, open surgery)

Question 21

Cryptorchidism

Answer 21

failure of testes to descend into scrotum through inguinal canal
3rd trimester
may descend spontaneously on their own after birth
abdominal scarring, abnormal SRY gene on Y chromosome
androgen-dependent

Risk factors: mother taking hormone replacements, pesticides
associated with sub-fertility and testicular cancer

Corrected by: orchiopexy - placement of testes in scrotum
surgical/laproscopically
sperm production improves, risk of testicular cancer drops
done by 12 mths of age

Question 22

Congenital adrenal hyperplasia

Answer 22

enzymatic deficiency cause overproduction of androgens from adrenal gland
no negative feedback from adrenal gland
excessive androgen –> virilization of external genitalia on girls, no effect on internal

Question 23

Hypospadia

Answer 23

abnormal development of urethral folds and genital tubercle
urethral meatus opens proximal to glans
incomplete foreskin and chordee (ventral penile curve)
can’t urinate standing up, can’t inseminate
Tx: reconstructive surgery

Question 24

Histology of urethra

Answer 24

Prostatic/membranous: urothelium
penile: stratified columnar
navicular fossa: stratified squamous