Posterior urethral valve and vesicoureteric reflux

Views:
 
Category: Education
     
 

Presentation Description

Data compiled from Radiographics regarding the commonly encountered neonatal vesicoureteric reflux and biomechanism of posterior urethral valves

Comments

Presentation Transcript

Posterior Urethral Valve and Vesicoureteric Reflux:

Posterior Urethral Valve and Vesicoureteric Reflux Dr. Varun Babu RadioGraphics 2002; 22:1139–1164

Vesicoureteric Reflux:

Primary maturation abnormality of VUJ Short distal ureteric submucosal tunnel in bladder Isolated anomaly or a/w PUV or complete duplication of urinary tract Predisposes to renal infection ( pyelonephritis ) Higher grades – renal parenchymal scarring MCUG – gold standard for diagnosis Alternate techniques – nuclear cystography , echo enhanced cystosonography Vesicoureteric Reflux

Grades of VUR Based on Guidelines of the International Reflux Study Committee:

Grades of VUR Based on Guidelines of the International Reflux Study Committee I Ureter only II Ureter , pelvis, and calices; no dilatation; normal caliceal fornices III Mild or moderate dilatation or tortuosity of the ureter and moderate dilatation of the renal pelvis; no or slight blunting of the fornices IV Moderate dilatation or tortuosity of the ureter and moderate dilatation of the renal pelvis and calices; complete obliteration of the sharp angle of the fornices but maintenance of the papillary impressions in the majority of calices V Gross dilatation and tortuosity of the ureter ; gross dilatation of the renal pelvis and calices; papillary impressions are no longer visible in the majority of the calices

Posterior Urethral Valves:

MC congenital obstruction of male urethra Thick valve like membrane from tissue of Wolffian duct that courses obliquely from the verumontanum to the most distal part of the prostatic urethra Posterior Urethral Valves

Young’s Classification of PUV:

I Mucosal folds extending antero inferiorly from caudal aspect of verumontanum often fusing anteriorly at a lower level. (derived from plicae colliculi ) II Mucosal folds extending anterosuperiorly from verumontanum towards the bladder neck III Disc like membranes located below the verumontanum Young’s Classification of PUV

Type I Type II:

Type I Type II

Type III:

Type III

Pathophysiology :

Pathophysiology

Pathophysiology :

Pathophysiology

Pathophysiology:

Pathophysiology

Clinical presentation :

UTI Fever, vomiting, jaundice, hematuria Obstructive symptoms Straining to void, dribbling, incontinence Palpable kidneys/bladder in neonate Prenatal diagnosis Failure to thrive Neonatal urine leak Clinical presentation

VCUG:

Diagnostic Dilatation & elongation of posterior urethra Rarely linear radiolucent band corresponding to the valve Bladder neck hypertophies – appears narrow Bladder wall trabeculation , thickening and diverticuli VUR VCUG

Prenatal Diagnosis – D/Ds:

Transient HUN and bladder distention – normal variant b/l congenital PUJ obstruction Prune Belly syndrome * – urethral obstruction malformation complex Megacystitis - microcolon -intestinal- hypoperistalsis syndrome Multicystic kidneys, polycystic kidneys Prenatal Diagnosis – D/Ds * The syndrome is named for the wrinkled appearance of the distended and lax abdominal wall that results from the absence of rectus muscles. Bilateral, nonpalpable undescended testes are present, and there is an abnormal urinary tract characterized by tortuous, dilated ureters ; a megalocystic , dilated prostatic urethra; and renal dysmorphism . This syndrome is also called Eagle-Barrett syndrome and triad syndrome

authorStream Live Help