UPJO and VUR Flashcards
What is Ureteopelvic junction obstruction (UPJO)?
Restriction to the flow of urine from the renal pelvis to the ureter, which if left uncorrected will lead to progressive renal deterioration and complete loss of affected kidney
Is the UPJO congenital or acquired?
It is mainly congenital condition that can be detected by antenatal ultrasound during the second trimester
The flow of urine from the renal pelvis to the ureter depends on two main factors
firstly, the pressure within the renal pelvis and its compliance
Secondly, the peristaltic activity of the ureter (the main cause of congenital ureteropelvic junction obstruction)
What is ureterocele
It is a cystic dilation of the terminal ureter between the superficial and deep layers of the trigone that may be ectopic or intravesical
Ureterocele is more common in females or males?
More common in females (4:1 ratio)
80% of all ureterocele arise from which pole of duplicated system
From the upper poles
Single system ureteroceles are sometimes called ————-
Simple ureteroceles
Simple ureteroceles are usually found in
Adults
What are the complications of large Ureterocele?
Obstruction of the bladder neck or contralateral ureteral orifice resulting in hydronephrosis of the collecting system
Diagnosis of Ureteroceles
1-sonography
2-excretory urography often demonstrates the characteristic cobra head deformity an area of increased density, similar to the head of a cobra with hello or less dense shadow around it
3-cystogrphy demonstrates the ureterocele in the bladder. It appears as a smooth, broad-based filling defect located near the trigone
Treatment of ureterocele
Endoscopic treatment:
By incising the ureterocele at the base
Surgical treatment:
Excision and re-implantation of the ureter
What is Vesicouretric Reflux (VUR)?
Is the retrograde flow of urine from the bladder into the upper urinary tract with or without dilation of the ureter, renal pelvis and calyces. It can cause symptoms and may lead to renal failure.
70% of infants who present with UTIs have VUR
🙂
The vast majority of VUR occurs in males or females?
85% of reflux occurs in females
Why siblings of patients with reflux are at much greater risk of having reflux than the normal population
Because Vesicoureteric Reflux is the most common inherited anomaly of the genital urinary tract
Physiology of vesicoureteric junction during emptying
The distal part of the ureter is continuous with the bladder obliquely, creating an orifice that remains closed due to its obliquity,
The ureteric peristalsis cause a rise in the ureteric pressure, which opens the orifice momentarily to propel urine into the bladder,
After you were in propulsion, the ureter loses its pressure and intravesical pressure rise, closing the intramural part of the ureter
Causes of VUR
Decreased intramural ureteric length to ureteric diameter ratio 5:1
Or
Ectopic ureteric opening
VUR of childhood tends to resolves with increasing age
Because, as the bladder grows the intramural ureter lengthens
etiology of VUR
🟢Primary
Congenital anomaly, resulting in too short intramural ureter
🟢Secondary
Bladder outlet obstruction (BPH, urethral stricture,)
Poor bladder compliance ()
🟢Iatrogenic (following incision of a ureterocele, inflammatory conditions, such as TB, schistosomiasis, UTI)
Clinical presentation of VUR
🟢UTI symptoms
🟡Loin pain associated with full bladder or immediately after micturition
🟣Failure to thrive in newborns
High index of suspicion of VUR
Recurrent UTI, or low in pain for many years before seeking medical advice
Management of VUR
Low dosage, prophylactic antibiotic therapy until resolution of reflux
Improving toilet hygiene and bladder emptying by means of timed voids, double voiding, proper, perineal wiping and elimination of constipation
Anticholinergics for bladder dysfunction
Periodic urine cultures, every three months looking for infections
