Urogenital Development Flashcards
What is this describing?
Collection of peritoneal fluid in the scrotum which enters through a patent processus vaginalis (5% of newborn boys).
Hydrocele
What is this a presentation of?
Painless fluctuant scrotal swelling, can be uni/bilateral, non-tender, irreducible, transilluminates, can ‘get above it’.
Hydrocele
What is the management of hydrocele?
- Most resolve within a few months (observe in <2 year olds).
- If it persists beyond age 2 - surgical repair (communicating hydrocele)
- Excellent prognosis, rarely recur.
- In adolescents - most commonly idiopathic and non-communicating - observe/surgery
What is this describing?
One/both testes not palpable in scrotum (80% unilateral), usually resulting from failure of normal descent of testes during third trimester.
Cryptorchidism (undescended testes)
What is the management for cryptorchidism?
- Initially conservative, most descend spontaneously, refer by 6 months if not.
- If not fully descending by 1 year, orchidopexy (reposition and fixate) due to risk of infertility and malignancy.
What is renal agenesis?
Failure to develop one or both kidneys.
What are the clinical features of renal agenesis?
Oligohydramnios, pulmonary hypoplasia
How is renal agenesis diagnosed?
Prenatal USS
What is the management for renal agenesis?
- Bilateral - poor prognosis, death due to respiratory insufficiency.
- Unilateral - normal life, monitor kidney growth and function and blood pressure.
What are duplex kidneys?
Normal anatomical variant, duplication of pelvicalyceal and ureteric systems.
What are the clinical features of duplex kidneys?
- Asymptomatic, incidental finding
2. Recurrent UTIs - prone to hydronephrosis and vesicoureteric reflux
How are duplex kidneys diagnosed?
Renal USS
What is the management of duplex kidneys?
- No management if asymptomatic
2. Children with recurrent UTIs - prophylactic antibiotics
Where is a horseshoe kidney normally found and why?
- Pelvis
2. Iliac vessels prevent upwards migration during foetal development
What are the clinical features of a horseshoe kidney?
- Many are asymptomatic
2. Obstructive uropathy, renal infections
How is a horseshoe kidney diagnosed?
Renal USS showing that kidneys are too medial and lower pole is too long.
What is this describing?
Dilation of the renal collecting system as a consequence of blockage/reflux at positions along the urinary tract.
Hydronephrosis
What are the causes of hydronephrosis?
- Obstruction at pelviureteric junction/VUJ or bladder neck
2. Reflux at the VUJ
What are the clinical features of hydronephrosis?
Usually asymptomatic
How is hydronephrosis diagnosed?
- Identified on antenatal USS or USS for recurrent UTIs
2. Determine underlying cause by micturating cystourethrography
What are posterior urethral valves?
Congenital abnormality where a membrane develops in the posterior neck of the urethra in the region of the prostate, obstructing the flow of urine from the bladder.
Which gender is more affected by posterior urethral valves?
Males, females are not affected.
What is this a presentation of?
Dribbling of urine and poor urinary stream, enlarged bladder, bilateral hydronephrosis secondary to obstruction and reflux, recurrent UTIs.
Posterior urethral valves
How are posterior urethral valves diagnosed?
USS scan, micturating cystourethrography
What is the management for posterior urethral valves?
Catheter and surgical ablation of the valve
What is this describing?
Backward flow of urine from the bladder into the ureters and towards the kidneys, dilation of the renal tract. Affects girls more commonly than boys, frequently familial.
Vesicoureteric reflux
What causes vesicoureteric reflux?
Anatomical anomalies at the VUJ or secondary conditions (e.g. posterior urethral valves).
What are the clinical features of vesicoureteric reflux?
- Recurrent UTIs/pyelonephritis
2. Recurrent infections lead to scarring of kidney (reflux nephropathy)
How is vesicoureteric reflux diagnosed?
- Either detected following investigations for an antenatal diagnosis of hydronephrosis or following a UTI in an infant.
- Severity of reflux graded (I-V)
- Micturating cystourethrography
What is the management for vesicoureteric reflux?
- Prophylactic antibiotics (trimethoprim at night)
- Most children grow out of problem
- Surgery if recurring UTIs/severe reflux/scarred kidneys
What is this describing?
Opening of the urethra is not in its usual position at the tip of the penis. It is located anywhere along the ventral aspect. Leads to a proximal displaced urethral meatus.
Hypospadias
What are the clinical features of hypospadias?
- 80% are mild - meatus at glans
- 15% are on the shaft
- 5% in scrotum/perineum
What should be avoided in hypospadias and why?
- Circumcision
2. Foreskin may be required for corrective surgery
