260 likes | 602 Views
Urology Board Review. November 16, 2010. Urinary Tract Dilation. Hydronephrosis Hydroureteronephrosis Pyelectasis Pyelocaliectasis Screening of fetus Need postnatal U/S If not urgent 3-10 days Allow increased urine production to fill out defects 20% resolution
E N D
Urology Board Review November 16, 2010
Urinary Tract Dilation • Hydronephrosis • Hydroureteronephrosis • Pyelectasis • Pyelocaliectasis • Screening of fetus • Need postnatal U/S • If not urgent 3-10 days • Allow increased urine production to fill out defects • 20% resolution • f/u ultrasounds at several months and 1 year
Question 1 On discharge examination of a female newborn infant, you notice a palpable mass in the right abdomen. An abdominal ultrasound reveals hydronephrosis. What is the next study that should be performed? A. IVP B. Cystoscopy C. VCUG D. Renal Scan E. No intervention at this time
Urinary Tract Dilation • Postnatal hydronephrosis • Complete radiographic eval • VCUG** • Rule out infravesical obstruction • VUR • Other • IV urography • True obstruction • Radionuclide scan • Function • Delay 4-6 weeks
Posterior Urethral Valves • Males • Common cause of infravesical obstruction • Associated with • Prenatal hydronephrosis • UTI • Incontinence • Renal Failure • Diminished urinary stream
Posterior Urethral Valves • Neonates • Pulmonary hypoplasia • Renal failure • Bladder distention • Hydroureteronephrosis • Older children • Incontinence • Renal failure
Posterior Urethral Valves • Diagnosis • VCUG • Treatment • Endoscopic fulguration • Cutaneousvesicostomy • Smaller babies • Prognosis • Renal dysplasia • Bladder compliance • Worse prognosis if poorly compliant • Reflux and hydronephrosis will not improve
Cryptorchidism • 33% preemies • 3% Full term • Associated abnormalities • Renal ultrasound • Urinary tract abnormalities are rare • Hypospadias w/ unilateral cyptorchidism • Intersex anomalies - karyotype • Bilateral nonpalpable testes • Endo eval • FSH, LH, testosterone • Treatment • Correction at 6-12 months • Could resolve on its own during this time • Cancer and Fertility risk
Prune-Belly Syndrome • AKA Eagle-Barrett Triad • Boys • 1/35,000-50,000 • Triad • Abnormal abdominal musculature • Abdominal cryptorchidism • Floppy dysmorphic urinary tracts • VUR
Prune-Belly Syndrome • Other findings • Megalourethra • Prostatic hypoplasia • Dimples on lateral knees • GI • Cardiac • Risks • UTI with sepsis • Careful catheterization • Prognosis • Renal dysplasia
Question 2 A mother brings her infant into the office because she has noticed a continual drainage from her umbilicus. You suspect a patent urachus. You explain to the mother that this results from an abnormal communication between . . . A. The bladder and umbilicus B. A ureter and the umbilicus C. The small intestine and the umbilicus D. The renal pelvis and the umbilicus E. The colon and the umbilicus
Urachus • Bladder dome to umbilicus • Vestigial structure • Persistence • Patent urachus • Vesicourachaldiverticulum • Urachal cyst • Urachal sinus • Dx • U/S • CT • Tx • Excision • Source of carcinoma in adults
Urachal Abnormalities • Patent • Communication remains • Umbilical drainage • Inflammation • Infection • Urachal cysts • Infection • Adulthood • Suprapubic or infraumbilical pain, tenderness, palpable mass or abdominal wall inflammation
Hydronephrosis • UPJ Obstruction • Presentation • Antenatal hydronephrosis • Neonatal flank mass • UTI • Recurrent abdominal pain • Co-existing VUR
Hydronephrosis • UPJ Obstruction • Dx • U/S • IVP • Retrograde pyelography* • VCUG • Coextisting VUR • Renal scan • True obstruction
Hydronephrosis • Megaureter • Large ureter with or without intrarenalhydronephrosis • Causes • VUR • Ureterovesical obstruction • Local neurologic or muscular abnormality • Nonobstructive*
Hydronephrosis • Megaureter • Discovery • Antenatal U/S • UTI • Treatment • Some resolve spontaneously • Obstructive • Excision and reimplantation
Question 3 After palpating a left sided mass at a well visit in a 2 month old, a renal ultrasound shows that your patient has a multicystic dysplastic kidney. A renal scan of this dysplastic kidney is most likely to show . . . • Full function • No function • 50% function • 25% function • 75% function
Multicystic Renal Dysplasia • 2nd most common cause of renal enlargement in neonates • Discovery • Antenatal U/S • Abdominal mass • Dx • U/S • Enlarged kidney with non-communicating cysts • Renal scan • Multicystic kidneys rarely function
Multicystic Renal Dysplasia • Treatment • VCUG • Contralateral VUR • UPJ obstruction, PUV, megaureter and duplication • Long term F/U • 15% involute • Prognosis • Low risk • HTN • Infection • Malignancy
Simple Renal Cysts • Usually benign • Usually incidental finding • Evaluation • U/S • CT • Cyst aspiration if suspicious • DDx • Cystic Wilms tumor • Multilocular cystic dysplasia • Duplication anomaly with hydronephrosis • Calycealdiverticulum • Adult polycystic disease