Genito Urinary System short answer

Question 1

What is the difference between renal tract obstruction and hydronephrosis?

Answer 1

Renal tract obstruction can occur anywhere in the urinary tract and there are varying causes. Obstruction can lead to hydronephrosis which is distention of the pelvis & calices with urine due to ureter obstruction with atrophy of kidney parenchyma.

Question 2

Briefly describe 3 probable causes for hydronephrosis.

Answer 2

• Calculi -Renal calculi are formed and travel into the ureter. If large enough they will become lodged anywhere in the ureter and obstruct flow causing a build up of urine.
• Tumour – A tumour that compresses any part of the urinary tract enough to obstruct flow ill cause a blockage and therefore build-up of urine.
• Stricture/stenosis – The three most common sites are at the pelviureteric junction (PUJ) of the renal pelvis and the ureter, as the ureter enters the pelvis and crosses over the common iliac artery bifurcation, at the vesicoureteric junction (VUJ) as the ureter obliquely enters the bladder wall. These are also common sites for calculi obstruction. Stricture and stenosis at any of these points can cause obstruction and a build up of urine.
• an enlarged prostate can cause obstruction to the urethra which in turn results in the bladder distending with urine and if this persists may result in the ureters and the kidneys also dilating and then it is termed hydronephrosis which in this case is due to obstruction from the enlarged prostate.

Question 3

Identify 3 developmental variants of the kidneys and explain any associated complications.

Answer 3

The most common complications of ectopic kidneys occur from obstruction, infection & urolithiasis.

Horseshoe kidneys function normally and are not more susceptible to renal disease than normal kidneys, except that the incidence of calculi and infection is said to be slightly increased, possibly due to angulation of the ureters and stasis.

Renal agenesis can be bilateral or unilateral. The prognosis with unilateral agenesis is normal but can be associated with other developmental abnormalities.
Bilateral renal agenesis is a lethal condition, usually in the neonatal period due to pulmonary hypoplasia.
duplex collecting system- predisposition to hydronephrosis as depending on if have one or 2 ureters and how they insert in bladder may result in poor drainage
supernumery kidneys-extra kidney usually no problems
malrotated kidneys-prone to infection
persistent fetal lobulations-no issues (looks weird)
hypertrophied column of Bertin (can be mistaken for a mass)
junctional defect(can mimic renal scarring from pyelonephritis)

Question 4

Describe a complication of vesico-ureteric reflux.

Answer 4

Vesicoureteric reflux (VUR) is the term for the abnormal flow of urine from the bladder into the upper urinary tract and is typically encountered in young children.
Reflux from the bladder into the upper urinary tract predisposes to pyelonephritis by allowing entry of bacteria to the usually sterile upper tract.
Significant vesicoureteral reflux, if untreated, may lead to recurrent urinary tract infections, renal scarring, and eventually renal failure (reflux nephropathy).

Question 5

What is schistosomiasis and which organ is typically affected?

Answer 5

Schistosomiasis is the result of infection by blood fluke of the Schistosoma species. S. hematobium is the species that usually infects the human bladder tissue, while the other species usually infect the bowel tissue.

Question 6

Compare the differences between a hydrocele a varicocele and a spermatocele. What is the significance of a hydrocele?

Answer 6

Hydroceles are acquired or congenital serous fluid collections between the layers of the tunica vaginalis surrounding a testis or spermatic cord. They are the most common form of “testicular” enlargement and present with painless enlargement of the scrotum.

Hydroceles can be diagnosed at any age, with congenital hydrocele being more common in children.
The most common causes of acute scrotal pain and/or swelling are torsion of the testicular appendage (appendix testis), epididymitis and testicular torsion. Delays in surgical management of testicular torsion result in higher rates of testicular loss (>40%). Hydrocele diagnosis is significant as reactive hydroceles occur in up to 20% of cases of testicular torsion and can be a differential diagnosis for children who present with scrotal swelling.

When there is an enlargement of the scrotum it is important to determine the cause as usually when this is due to a testicular mass then the outcome is typically poor.
whereas a hydrocele is a more benign condition and often occurs in older males.

Varicocele is the dilatation of the pampiniform plexus of veins, a network of many small veins found in the male spermatic cord. Varicoceles can be asymptomatic. If symptomatic, presentations include: scrotal mass/swelling, scrotal pain, testicular atrophy, infertility or subfertility.

Spermatoceles are a common type of extra testicular cyst, and represents cystic dilatation of tubules of the efferent ductules in the head of the epididymis. They usually present as a painless, incidental finding but can present as a mass lesion if large

Question 7

Explain torsion of the testes and comment on the significance of this pathology.

Answer 7

Testicular torsion occurs when a testicle torts on the spermatic cord resulting in the cutting off of blood supply. The most common symptom is acute testicular pain and the most common underlying cause, a bell-clapper deformity (when the tunica vaginalis joins high on the spermatic cord, leaving the testis free to rotate)
There is an 80 % success rate if operated on within 6 hours. Haemorrhagic infarction of the testis, epididymis and distal end of the cord can occur secondary to torsion of the cord.
Delays in surgical management of testicular torsion result in higher rates of testicular loss (>40%). Common causes of delay include location of presentation, use of ultrasound, and transferring to a tertiary centre.