Common Urogenital Anomalies

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Common Urogenital Anomalies:

Common Urogenital Anomalies Dr. Abdelazim Hussein Khalafalla Ass . Professor R ibat U rological C entre N ational R ibat U niversity

Common Urogenital Anomalies:

Common Urogenital Anomalies Renal agenesis Renal ectopia Horseshoe kidney Congenital cystic kidneys PUJO Duplex System Bladder exstrophy PUV Hypospadias Cryptorchidism

Horseshoe kidney :

Horseshoe kidney Most common example of renal fusion The kidneys lie vertically (instead of obliquely) and are joined at their lower poles (in 95%) by midline parenchymal tissue (the isthmus

Horseshoe kidney :

Horseshoe kidney The inferior mesenteric artery obstructs ascent of the isthmus the horseshoe kidney lies lower in the abdomen (L3 or L4 vertebral level Normal rotation of the kidney is also prevented and therefore the renal pelvis lies anteriorly

presentation:

presentation Asymptomatic; Infection Calculi

PowerPoint Presentation:

The diagnosis is usually suggested on renal ultrasound and confirmed by IVU

Pelvic kidney :

Pelvic kidney This represents a form of renal ectopia Pelvic kidneys lie opposite the sacrum Renal pelvis positioned anteriorly Ureter is short ِِِ Asymptomatic. Diagnosis is made on renal ultrasound scan, IVU,CT. TTT of complication

Congenital cystic kidneys:

Congenital cystic kidneys Can be classified into genetic and non-genetic types. Genetic Autosomal recessive polycystic kidney disease Autosomal dominant polycystic kidney disease Non-genetic Multicystic dysplastic kidney

Congenital cystic kidneys:

Congenital cystic kidneys Autosomal recessive polycystic kidney disease A disease of infancy and childhood where renal collecting tubules and ducts become cystically dilated Infants ---- develop fatal uraemia Adulthood ---requiring haemodialysis and renal transplantation

Congenital cystic kidneys:

Congenital cystic kidneys Typically presents in adulthood complications :- haematuria, flank pain, flank mass, UTI, proteinuria, hypertension, and intracerebral bleeds multiple expanding cysts of both kidneys that ultimately destroy the intervening parenchyma, and accounts for 10% of all chronic renal failure. Ttt :_of complication

Ureteropelvic junction obstruction :

Ureteropelvic junction obstruction The ureteropelvic junction is the most common site of urinary tract obstruction AE - intrinsic muscular defect - Aberrant blood vessels - valvular mucosal folds - upper ureteral polyps C/P – pain ,UTI, mass ,uremia Investigation – US, IVU , CTU TTT - Pyeloplasty

Posterior Urethral Valve:

Posterior Urethral Valve Abnormal congenital mucosal folds in the prostatic (posterior) urethra causing lower urinary tract obstruction. May be due to failure of complete disintegration of the urogenital membrane

Incidence:

Incidence Incidence .one in 5000 males Affects only males Most common cause of obstructive uropath

Classification :

Classification Type I (95%) Membranes arise from the distal lateral aspect of the verumontanum, which extend distally and anteriorly to fuse in the midline. Type II Longitudinal folds extending from the verumontanum to bladder neck. nonobstructing( not true valve.) Type III A diaphram-like membrane found distal or proximal to the verumontanum.

Pathology:

Pathology PUV---Obstruction-- Dilatation of the prostatic urethra------ intravesicular pressures leading to reflux nephropathy Reflux nephropathy ---peritubular and interstitial fibrosis --- echogenic appearance of the renal parenchyma on ultrasound

Presentation:

Presentation Prenatal US features Bilateral hydroureteronephrosis; Pot-natal features Recurrent UTI; Poor urinary stream; Incomplete bladder emptying; Poor growth and incontinence. Risk of renal failure (vesicoureteric reflux)

Treatment:

Treatment Prenatal presentation Postnatal presentation

Investigation:MCUG:

Investigation:MCUG

Treatment :

Treatment Prenatal intervention. -Vesicoamniotic shunts Postnatal intervention . Endoscopic fulguration

Vesicoureteral reflux (VUR) :

Vesicoureteral reflux (VUR) Valve ablation results in (Concerning VUR) One-third --Spontaneous resolution One-third --Do well with antibiotic prophylaxis One-third --- Require reimplantation.

Prognosis :

Prognosis 35% poor renal function; 20% develop end-stage renal failure.

Hypospadias:

Hypospadias Hypospadias is an association of three anatomical anomalies: • an abnormal ventral opening of the urethral meatus • ventral curvature (chordee) of the penis • a hooded foreskin, which is deficient ventrally.

PowerPoint Presentation:

1 in 300 live male births Endocrinopathy Classification Glanular Coronal Distal Mid shaft Proximal Perineal

TTT:

TTT Two-stage repair Correction of penile chordee Tubularising the urethral plate

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