UT developmental abnormalities

Question 1

Hydronephrosis

Answer 1

dilatation of renal pelvis by accumulated urine due to obstruction

Question 2

Most common cause of hydronephrosis

Answer 2

uteropelvic junction (UPJ) obstruction
- common in newborn boys

note:

• upper pole: prone to obstruction
• lower pole: prone to reflux

Question 3

Uteropelvic junction obstruction is a result of what?

Answer 3

incomplete canalization of ureteric bud 12 weeks gestation and/or
local abnormality of sm fibers w/ fibrosis impeding peristalsis

Question 4

hydroureter

Answer 4

dilatation of ureter by accumulated urine due to obstruction

Question 5

Most common renal abnormality

Answer 5

ureteral duplication (2 ureters ipsilaterally)
- propensity for vesicoureteral reflux

note:

• upper pole: prone to obstruction
• lower pole: prone to reflux

Question 6

Failure to toilet train or continuous drip incontinence is suggestive of what renal abnormality?

Answer 6

ureteral duplication

Question 7

Ureterocele

Answer 7

cystic dilation of terminal intravesical ureter
(portion w/in bladder wall at the jxn)
- can be obstructive if the orifice is stenotic or ectopically located –> reflux –> hydroureter

Question 8

Reflux

Answer 8

backflow of urine up the urinary tract upon contraction of the detrusor muscle during micturition

Question 9

ectopic ureterocele

Answer 9

ectopic (means wrong place)

ureterocele at the bladder neck or the urethra (regardless of position of orifice)

Question 10

urachal remnant

Answer 10

connects dome of fetal bladder to allointois in umbilical cord

normally: involutes to form median umbilican ligament
- if kid pees and has umbilical pain, sum’ns wrong with urachal development: cyst, sinus, or fistula

Question 11

Megalocystitis/ megacystitis

Answer 11

abnormal distention of the bladder due to bladder outlet obstruction

Question 12

Posterior urethral valves

Answer 12

abnormal congenital obstructing membrane in the posterior male urethra.

results from abnormal insertion of mesonephric duct on the cloaca –> increased intraluminal pressure

Question 13

Most common cause of bladder outlet obstruction in boys

Answer 13

posterior urethral valves

Question 14

hypospadias

Answer 14

orifice of penile urethra along ventral aspect of penis

- results from abnormal fusion of urogenital folds from androgen insufficiency

Question 15

Chordee

Answer 15

fibrous band causing the penis to curve

- associated with hypospadias

Question 16

epispadias

Answer 16

orifice of urethral opening on dorsal aspect of penis

- less common

Question 17

extrophy

Answer 17

arises from failure of separation by urorectal septum of primitive cloaca into the urogenital sinus and anorectral canal at 6 weeks

Question 18

consequences of fetal urinary tract obstruction or renal agenesis

Answer 18

(recall that less urine = less amniotic fluid/oligohydramnios)

1. Potters facies
2. Amnion nodosom
   - sign of squamous sloughing
3. PULMONARY HYPOPLASIA
   - underdeveloped lungs