UPJO and VUR

Question 1

What is Ureteopelvic junction obstruction (UPJO)?

Answer 1

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

Question 2

Is the UPJO congenital or acquired?

Answer 2

It is mainly congenital condition that can be detected by antenatal ultrasound during the second trimester

Question 3

The flow of urine from the renal pelvis to the ureter depends on two main factors

Answer 3

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)

Question 4

What is ureterocele

Answer 4

It is a cystic dilation of the terminal ureter between the superficial and deep layers of the trigone that may be ectopic or intravesical

Question 5

Ureterocele is more common in females or males?

Answer 5

More common in females (4:1 ratio)

Question 6

80% of all ureterocele arise from which pole of duplicated system

Answer 6

From the upper poles

Question 7

Single system ureteroceles are sometimes called ————-

Answer 7

Simple ureteroceles

Question 8

Simple ureteroceles are usually found in

Answer 8

Adults

Question 9

What are the complications of large Ureterocele?

Answer 9

Obstruction of the bladder neck or contralateral ureteral orifice resulting in hydronephrosis of the collecting system

Question 10

Diagnosis of Ureteroceles

Answer 10

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

Question 11

Treatment of ureterocele

Answer 11

Endoscopic treatment:
By incising the ureterocele at the base

Surgical treatment:
Excision and re-implantation of the ureter

Question 12

What is Vesicouretric Reflux (VUR)?

Answer 12

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.

Question 13

70% of infants who present with UTIs have VUR

Answer 13

🙂

Question 14

The vast majority of VUR occurs in males or females?

Answer 14

85% of reflux occurs in females

Question 15

Why siblings of patients with reflux are at much greater risk of having reflux than the normal population

Answer 15

Because Vesicoureteric Reflux is the most common inherited anomaly of the genital urinary tract

Question 16

Physiology of vesicoureteric junction during emptying

Answer 16

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

Question 17

Causes of VUR

Answer 17

Decreased intramural ureteric length to ureteric diameter ratio 5:1

Or

Ectopic ureteric opening

Question 18

VUR of childhood tends to resolves with increasing age

Answer 18

Because, as the bladder grows the intramural ureter lengthens

Question 19

etiology of VUR

Answer 19

🟢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)

Question 20

Clinical presentation of VUR

Answer 20

🟢UTI symptoms
🟡Loin pain associated with full bladder or immediately after micturition
🟣Failure to thrive in newborns

Question 21

High index of suspicion of VUR

Answer 21

Recurrent UTI, or low in pain for many years before seeking medical advice

Question 22

Management of VUR

Answer 22

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