W4L6 UT Anomalies

Question 1

Ureteropelvic
 Obstruction (UPJO) etio

Answer 1

• most common UObs in child
• 85% antenatally
• 2/3 boys
• 60% left side
• 20% bilat

Question 2

UPJO present

Answer 2

• Antenatal US
• Incidental
• Abd mass
• Febrile UTI
• Abd pain
• Hematuria

Question 3

UPJO diag

Answer 3

• renal/bladder us
• diuretic renogram
• MRU

Question 4

Ttt UPJO

Answer 4

1. Watchful waiting:
   - Antenatal case
   - US(3m)
2. Surgery:
   - Indications:
   
   • Symptomatic
     - Hydronephrosis
   • Deterio renal fx
   • Bilateral
     - Procedure:
   • Open surgery (pyeloplasty)
   • Laparoscopy
   • Endoscopy
     - non functioning: Nephrectomy

Question 5

Vesicoureteral reflux(VUR) etio

Answer 5

• 1% child
• 10% antena hydronephrosis
• risk factor:
  
  • Pyelonephritis(40% VUR)
  • Renal scarring/damage
  • HTN
  • CKD & ESRD
• 1ry/2ry

Question 6

VUR present & diag

Answer 6

• Antenatal
• Pyelonephritis
• Ultrasound
• VCUG
• DMSA renal scan(fx, renal scarring)

Question 7

Ttt VUR

Answer 7

1. Conservative
   - Spontaneous(common)
   - Reflux wo UTI(harmless)
   - Ab prophylaxis
   - US every 6 month
   - VCUG every year
2. Surgery
   - when breakthrough UTIs
   - Procedure
   • Open surgery (ureteral reimplantation/ureterovesical reimplantation)
   • Laparoscopy
   • Endoscopy (inject bulking agent)
   • Nephrectomy(non/ poorly fx kidney)

Question 8

Obstructive (Primary) Megaureter

Answer 8

• Obstructive dilate ureter above adynamic ureteral segment at ureterovesical jx
• ttt ureterovesical reimp

Question 9

POSTERIOR URETHRAL VALVES (PUV) etio

Answer 9

• 1/8000
• M only
• most com coz LUTObs

Question 10

CP PUV

Answer 10

1. Antenatal diag(90%)
   - key hole sign
   - hydronephrosis
   - oligohydramnio
2. Neonates
   - distended bladder
   - hydronephrosis
3. Old child
   - UTI
   - weak stream
   - incontinence

Question 11

PUV imaging

Answer 11

• US
• VCUG
• Renogram

Question 12

PUV manage

Answer 12

1. Urine retention/high SCr
   - Catheter drainage
   - Antibiotics
   - Correct electrolyte/acid base imbalance
2. Primary valve ablation
3. Vesicostomy

Question 13

Hypospadias etio

Answer 13

• 1:300 M
• distal(50%)
• asso anom
  
  • UDT(9%)
  • Hernia(9%)

Question 14

HYPOSPADIAS type

Answer 14

1. Ventral opening of external meatus
2. Ventral penile curvature
3. Ventrally deficient foreskin

Question 15

Hypospadias

Answer 15

1. Complaints:
   -Functional
   • Voiding
   • Sexual
   -Cosmetic
   -Asso anom
2. Inv(selected case)

Question 16

Hypospadias repair 6-16m?

Answer 16

• Orthoplasty (straightening)
• Meatoplasty & Glanuloplasy
• Urethroplasty
• Skin Cover
• Scrotoplasty

Question 17

Hypospadias repair 6-24m?

Answer 17

• avoid circumcise b4 repair
• Orthoplasty (straightening)
• Meatoplasty & Glanuloplasy
• Urethroplasty
• Skin Cover
• Scrotoplasty