L9: Congenital Anomalies of Urinary Tract Flashcards
Normal Kidney Radiology
Terminology of Endoscopic Ultrasound (EUS)
Def of Hydronephrosis
Dilatation of the renal pelvis and calyces with urine.
Incidence of Antenatal Hydronephrosis
- The commonest anomaly detected on prenatal ultrasound (US).
- Reported in 1-4% of all pregnancies.
SFU Grading of Antenatal Hydronephrosis
Causes of Antenatal Hydronephrosis
Causes of Antenatal Hydronephrosis
- Most Common Cause
Transient Hydronephrosis
Causes of Antenatal Hydronephrosis
- Most Common Pathological Cause
Ureteropelvic Junction Obstruction (UPJO)
Causes of Antenatal Hydronephrosis
- Most Common Cause in Boys
Posterior Urethral Valve (PUV).
Prognosis of Antenatal Hydronephrosis
- 50% of ANH resolve spontaneously.
- Only 10% require surgery.
Congenital Anomalies of Urinary Tract
Epidemeology of UPJO
Etiology of UPJO
- Abnormal canalization.
- Adynamic segment.
- Extrinsic cause.
CP (Presentation) of UPJO
- Antenatal US.
- Incidental.
- Febrile UTI.
- Abdominal pain.
- Hematuria.
- Abdominal mass.
INVx for UPJO
- Renal/Bladder US
- Diuretic Renogram
- MRU
INVx for UPJO
- US
INVx for UPJO
- Diuretic Renogram
INVx for UPJO
- MRU
TTT of UPJO
- Watchful Waiting
- Surgery
TTT of UPJO
- Watchful Waiting
- Antenatal cases.
- US every 3 months.
TTT of UPJO
- Surgery
Surgery in UPJO
- Indications
- Symptomatic.
- Progressive hydronephrosis.
- Deterioration of renai function.
- Bilateral.
Surgery in UPJO
- Procedures
Surgery in UPJO
- Pyelopalsty
Surgery in UPJO
- TTT approach & Risk Assessment
Incidence of Horseshoe Kidney
1/400.
Chatacters of Horseshoe Kidney
Def of VUR
- A dynamic event in which urine is flowing from the bladder towards the kidney.
Incidence of VUR
- 1% of children have VUR.
- 10% of ANH have VUR.
Etiology of VUR
CP of VUR
- Antenatally → Antenatal HN.
- Postnatally → May present with pyelonephritis.
Pathogenesis & Complications of VUR
INVx for VUR
- US
- VCUG
- DMSA
INVx for VUR
- US
INVx for VUR
- VCUG
For Grading
(The Best)
INVx for VUR
- Tc99m DMSA Renal Scan
- For assessment of renal function & scarring.
Grading of VUR
Grading of VUR
- Ureter
Grading of VUR
- Collecting System
Grading of VUR
- Fornices
Grading of VUR
- Renal parenchyma
TTT of VUR
- Conservative
- Surgery
TTT of VUR
- Conservative
TTT of VUR
- Surgery
Surgery in VUR
- Indications
Surgery in VUR
- Procedures
- Ureterovesical reimplantation
- Endoscopy
- Nephrectomy
Surgery in VUR
- Ureterovesical reimplantation
Surgery in VUR
- Endoscopy
Surgery in VUR
- Nephrectomy
if non/poorly functioning kidney.
Def of Primary Obstructive Megaureter
- Obstructive dilatation of the ureter above an adynamic ureteral segment at the ureterovesical junction.
TTT of Primary Obstructive Megaureter
TTT of Primary Obstructive Megaureter
- Temporary TTT (<1yr)
Urinary Diversion
- Terminal Ureterostomy (Cutaneous Ureterostomy)
TTT of Primary Obstructive Megaureter
- Permenant TTT (after 1 yr)
Uretero-vesical reimplantation.
Duplex Collecting System
(Ureteral Duplication - Duplex Kidney)
Def of Duplex Collecting System
- A complete or incomplete duplication of the collecting system (pelvicalyceal system and ureter).
Types of Duplex Collecting System
- Complete Dilatation
- Incomplete Dilatation
Types of Duplex Collecting System
- Complete Duplication
- Two ureteric buds arising from the Wolffian duct (Mesonephric ducts) → Kidney with 2 pelvicalyceal systems & 2 ureters.
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.
CP of Duplex Collecting System
Def of Ureterocele
- Cystic dilation of the intramural ureter (intravesical segment of ureter).
Effect of Ureterocele
- It obstructs the ipsilateral kidney and may obstruct the bladder neck or urethra (ectopic ureterocele).
Incidence of Ureterocele
It’s more common with duplex kidneys.
Def of PUV
- Congenital malformation in males only where membranous folds of the urogenital membrane obstruct the membranous and prostatic urethra (posterior urethra).
Epidemeology of PUV
- Most common cause of lower urinary tract obstruction in male neonates.
PUV
- Single most common urologic cause for chronic renal failure and need for renal transplantation in children.
PUV
CP of PUV
CP of PUV
- Antenatal
- Key-hole sign.
- Thick-walled bladder.
- Hydronephrosis.
- Oligohydramnios.
CP of PUV
- Neonatal
- Distended bladder.
- Hydronephrosis.
- Respiratory distress from pulmonary hypoplasia.
CP of PUV
- Older Children
- UTI.
- Difficulty/weak steam.
- Incontinence.
Read INVx & Management at the endddd
Def of Hypospadius
Epidemeology of Hypospadius
Dx of Hypospadius
Dx of Hypospadius
- Complaint
Dx of Hypospadius
- INVx
in selected cases
TTT of Hypospadius
TTT of Hypospadius
- Age of Repair
TTT of Hypospadius
- Steps of Repair
INVx in PUV
Management of PUV
