Urology Flashcards
What is Mayer-Rokitansky syndrome
Abnormalities of the vagina (agenesis), uterus, fallopian tubes associated mostly commonly with an absent kidney (unilateral)
How might someone with a UTI present?
How do you proceed?
Pyuria - presence of pus in the urine
- Urine culture
- Suprapubic aspiration
- Dipstick for nitrites
HIGH INDEX OF SUSPICION
What is the most commonest “surgical” cause of UTI?
Diagnosis
Management?
Vesicouretal reflux (VUR)
- May be diagnosed after UTI
- Antenatal diagnosis
- Secondary reflux when associated with other abnormalities
DMSA- reflux nephropathy
Mostly non-operative, many will stop refluxing after the age of 5
- Consider uroprophylaxis
- Good follow up
What is a STING procedure?
The purpose is to prevent urinary reflux
A polysaccharide is injected at the junction of the ureter and bladder. This procedure is done through the cystoscope.
What are the consequences of UTI ?
May result in pyonephrosis - destroy kidney
It may be diagnosed antenatally via ultrasound nuclear scan
UROPROPHYLAXIS
What is a mega-ureter?
A megaureter refers to an expanded or widened ureter that does not function normally. Rarely simple stenosis
Its not as common as a pelviureteric junction obstruction
May be associated with other problems like duplex system
-Associated urteroceles
MUST BE DIFFERENTIATED FROM VUR
What is PUV and how does it present?
Posterior urethral valves is a condition of the urethra occuring only in boys
It presents in the neonatal period.(Antenatally diagnosed and managed antenatally)
An infant may bevery ill
Outcome depends on initial renal damage
What can arise from failure of the processus vaginalis to obliterate completely
Different forms of inguinal hernia and hydrocele
What is an undescended testis (UDT)?
Describe its incidence
Is a testis that cannot be manipulated to the bottom of the scrotum, withoutundue tension of the spermatic cord
3% of newborn boys
2/3 descend spontaneously
Familial predisposition
Bilateral (10-25%) or Unilateral (Right=55%, Left=45%)
CLINICAL APPLICATION
How could you identify UDT?
Impalpable testis: absent, intra-abdominal or intra-canicular
Undescended testis: in the groin
Ectopic testis: abdominal wall, thigh, base of penis
Ascending testis
The most reliable investigation for an impalpable testis is: LAPAROSCOPY
What should be considered when using the Fowler-Stephens technique
- Ligation of the main testicular vessels in situ in the abdomen
- Do not mobilise the testis
2nd stage
- Orchidopexy (surgery to move an UDT)
When does the descent of testis in utero?
What factors might influence this?
The descent is completed in the third trimester
Hormonal
Mechanical factors
Role of the gubernaculum (aids in descent of gonads)
