L9: Congenital Anomalies of Urinary Tract Flashcards
1
Q
Normal Kidney Radiology
A
2
Q
Terminology of Endoscopic Ultrasound (EUS)
A
3
Q
Def of Hydronephrosis
A
Dilatation of the renal pelvis and calyces with urine.
4
Q
Incidence of Antenatal Hydronephrosis
A
- The commonest anomaly detected on prenatal ultrasound (US).
- Reported in 1-4% of all pregnancies.
5
Q
SFU Grading of Antenatal Hydronephrosis
A
6
Q
Causes of Antenatal Hydronephrosis
A
7
Q
Causes of Antenatal Hydronephrosis
- Most Common Cause
A
Transient Hydronephrosis
8
Q
Causes of Antenatal Hydronephrosis
- Most Common Pathological Cause
A
Ureteropelvic Junction Obstruction (UPJO)
9
Q
Causes of Antenatal Hydronephrosis
- Most Common Cause in Boys
A
Posterior Urethral Valve (PUV).
10
Q
Prognosis of Antenatal Hydronephrosis
A
- 50% of ANH resolve spontaneously.
- Only 10% require surgery.
11
Q
Congenital Anomalies of Urinary Tract
A
12
Q
Epidemeology of UPJO
A
13
Q
Etiology of UPJO
A
- Abnormal canalization.
- Adynamic segment.
- Extrinsic cause.
14
Q
CP (Presentation) of UPJO
A
- Antenatal US.
- Incidental.
- Febrile UTI.
- Abdominal pain.
- Hematuria.
- Abdominal mass.
15
Q
INVx for UPJO
A
- Renal/Bladder US
- Diuretic Renogram
- MRU
16
Q
INVx for UPJO
- US
A
17
Q
INVx for UPJO
- Diuretic Renogram
A
18
Q
INVx for UPJO
- MRU
A
19
Q
TTT of UPJO
A
- Watchful Waiting
- Surgery
20
Q
TTT of UPJO
- Watchful Waiting
A
- Antenatal cases.
- US every 3 months.
21
Q
TTT of UPJO
- Surgery
A
22
Q
Surgery in UPJO
- Indications
A
- Symptomatic.
- Progressive hydronephrosis.
- Deterioration of renai function.
- Bilateral.
23
Q
Surgery in UPJO
- Procedures
A
24
Q
Surgery in UPJO
- Pyelopalsty
A
25
Surgery in **UPJO**
- TTT approach & Risk Assessment
26
Incidence of **Horseshoe Kidney**
1/400.
27
Chatacters of **Horseshoe Kidney**
28
Def of **VUR**
- A dynamic event in which urine is flowing from the bladder towards the kidney.
29
Incidence of **VUR**
- 1% of children have VUR.
- 10% of ANH have VUR.
30
Etiology of **VUR**
31
CP of **VUR**
- Antenatally → Antenatal HN.
- Postnatally → May present with pyelonephritis.
32
Pathogenesis & Complications of **VUR**
33
INVx for **VUR**
- US
- VCUG
- DMSA
34
INVx for **VUR**
- US
35
INVx for **VUR**
- VCUG
For Grading
**(The Best)**
36
INVx for **VUR**
- Tc99m DMSA Renal Scan
- For assessment of renal function & scarring.
37
Grading of **VUR**
38
Grading of **VUR**
- Ureter
39
Grading of **VUR**
- Collecting System
40
Grading of **VUR**
- Fornices
41
Grading of **VUR**
- Renal parenchyma
42
TTT of **VUR**
- Conservative
- Surgery
43
TTT of **VUR**
- Conservative
44
TTT of **VUR**
- Surgery
45
Surgery in **VUR**
- Indications
46
Surgery in **VUR**
- Procedures
- Ureterovesical reimplantation
- Endoscopy
- Nephrectomy
47
Surgery in **VUR**
- Ureterovesical reimplantation
48
Surgery in **VUR**
- Endoscopy
49
Surgery in **VUR**
- Nephrectomy
if non/poorly functioning kidney.
50
Def of **Primary Obstructive Megaureter**
- Obstructive dilatation of the ureter above an adynamic ureteral segment at the ureterovesical junction.
51
TTT of **Primary Obstructive Megaureter**
52
TTT of **Primary Obstructive Megaureter**
- Temporary TTT (<1yr)
Urinary Diversion
- Terminal Ureterostomy (Cutaneous Ureterostomy)
53
TTT of **Primary Obstructive Megaureter**
- Permenant TTT (after 1 yr)
Uretero-vesical reimplantation.
54
**Duplex Collecting System**
(Ureteral Duplication - Duplex Kidney)
55
Def of **Duplex Collecting System**
- A complete or incomplete duplication of the collecting system (pelvicalyceal system and ureter).
56
Types of **Duplex Collecting System**
- Complete Dilatation
- Incomplete Dilatation
57
Types of **Duplex Collecting System**
- Complete Duplication
- Two ureteric buds arising from the Wolffian duct (Mesonephric ducts) → Kidney with 2 pelvicalyceal systems & 2 ureters.
58
Types of **Duplex Collecting System**
- Incomplete Dilatation
**Early division of the ureteric bud, two types:**
- Bifid Ureter: Kidney with 2 pelvicalyceal systems & 2 ureters that merge and share a single ostium into the bladder (Y-shaped ureter).
- Bifid Pelvis: Kidney with 2 pelvicalyceal systems that merge into a single ureter at the ureteropelvic junction.
59
CP of **Duplex Collecting System**
60
Def of **Ureterocele**
- Cystic dilation of the intramural ureter (intravesical segment of ureter).
61
Effect of **Ureterocele**
- It obstructs the ipsilateral kidney and may obstruct the bladder neck or urethra (ectopic ureterocele).
62
Incidence of **Ureterocele**
It's more common with duplex kidneys.
63
Def of **PUV**
- Congenital malformation in males only where membranous folds of the urogenital membrane obstruct the membranous and prostatic urethra (posterior urethra).
64
Epidemeology of **PUV**
65
- Most common cause of lower urinary tract obstruction in male neonates.
PUV
66
- Single most common urologic cause for chronic renal failure and need for renal transplantation in children.
PUV
67
CP of **PUV**
68
CP of **PUV**
- Antenatal
- Key-hole sign.
- Thick-walled bladder.
- Hydronephrosis.
- Oligohydramnios.
69
CP of **PUV**
- Neonatal
- Distended bladder.
- Hydronephrosis.
- Respiratory distress from pulmonary hypoplasia.
70
CP of **PUV**
- Older Children
- UTI.
- Difficulty/weak steam.
- Incontinence.
## Footnote
Read INVx & Management at the endddd
71
Def of **Hypospadius**
72
Epidemeology of **Hypospadius**
73
Dx of **Hypospadius**
74
Dx of **Hypospadius**
- Complaint
75
Dx of **Hypospadius**
- INVx
in selected cases
76
TTT of **Hypospadius**
77
TTT of **Hypospadius**
- Age of Repair
78
TTT of **Hypospadius**
- Steps of Repair
79
INVx in **PUV**
80
Management of **PUV**
