Urogenital

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Urogenital

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Sono 202 : 

Sono 202 The Fetal Urogenital System

Complete evaluation of the urogenital system includes: : 

Complete evaluation of the urogenital system includes: Both kidneys and adrenals Bladder Amniotic fluid volume

Renal pelvis dilation : 

Renal pelvis dilation 13-20 weeks (AP measurement 5 mm) 20-30 weeks (AP measurement 8 mm) 30-term (AP measurement 10 mm) Greater than 10 mm = 85% chance of having an anatomic abnormality. The normal bladder wall measures up to 2 mm in diameter. Ureteral jets –use color at the base of bladder

Renal Pelvis : 

Renal Pelvis

OBSTRUCTIVE UROPATHY : 

OBSTRUCTIVE UROPATHY

UPJ Obstruction : 

UPJ Obstruction Ureteropelvic junction- obstruction at the junction of the ureter entering the renal pelvis. Most common cause of fetal hydronephrosis. Sonographic findings: dilated renal pelvis presence of variable caliectasis thinning of renal cortex no hydroureter

UVJ Obstruction : 

UVJ Obstruction Obstruction at the level of the ureter entering the bladder. Sonographic findings: hydronephrosis and pelviectasis hydroureter usually normal AFI possible ureterocele

Slide 11: 

Megaureter

HYDRONEPHROSIS WITH MEGAURETER : 

HYDRONEPHROSIS WITH MEGAURETER Again One Works As Well As Two Rule Need To Assess After Birth Only 20-30% Will Need Surgery To Fix

Ureterocele : 

Ureterocele Cystic dilation of the intravesical segment of the distal ureter. Sonographic findings: cystic area at the base of the bladder.

Ureterocele : 

Ureterocele

Posterior urethral valve : 

Posterior urethral valve Bladder outlet obstruction. Typically seen in male fetus’s. Sonographic findings: bladder wall thickened with a dilated posterior urethra “key hole” sign. bilateral hydronephrosis and dilated ureters. moderate to profound oligohydramnios.

“Keyhole bladder” sign : 

“Keyhole bladder” sign

Prune Belly : 

Prune Belly Extreme dilation of the fetal bladder which leads to atrophy of the abdominal wall. Most commonly caused by PUV syndrome. Sonographic findings: oligohydramnios bilateral hydronephrosis and massively dilated bladder

Transverse of bladder : 

Transverse of bladder

RENAL ANomalies : 

RENAL ANomalies

Renal Agenesis : 

Renal Agenesis Complete absence of the kidneys, can be unilateral or bilateral (Potter’s syndrome). Potter’s syndrome consists of: pulmonary hypoplasia facial abnormalities small for dates oligohydramnios bladder not visualized * Don’t mistake adrenals for kidneys!

Polycystic Kidney Disease : 

Polycystic Kidney Disease Bilaterally enlarged echogenic kidneys comprised of extremely small cysts. Sonographic findings: large, echogenic kidneys with small bladder. 4 types: Perinatal- renal failure occurs in utero Neonatal- occurs within 1 month of birth, death within 1 year Infantile- 3-6 months of age Juvenile- appears at 1-5 years of age, less renal involvement

POLYCYSTIC KIDNEYS : 

POLYCYSTIC KIDNEYS VERY RARE (1 in 50,000) Lethal Disorder Little to No Amniotic Fluid (2nd Trimester)

Multicystic Dysplastic Kidney : 

Multicystic Dysplastic Kidney Unilateral or bilateral enlarged kidney with large cysts. Sonographic findings: multiple, peripheral cysts possible oligohydramnios bladder seen in unilateral cases

MULTICYSTIC KIDNEY : 

MULTICYSTIC KIDNEY One As Good As Two Rule Not Usually Life Threatening Need To Assess After Birth

Other Urinary Anomalies : 

Other Urinary Anomalies Urethral atresia- massive dilated bladder, prune belly Mesoblastic nephroma (hamartoma)- most common renal tumor, large, single solid mass Neuroblastoma-adrenal tumor

Neuroblastoma : 

Neuroblastoma

NEUROBLASTOMA : 

NEUROBLASTOMA Most Common Infant Cancer Usually Not Found Until Metastasis Usually Seen In Late 3rd Trimester Need To Always Double Check!!

Mesoblastic Nephroma : 

Mesoblastic Nephroma

Genital System Malformations : 

Genital System Malformations Hypospadias- abnormal openings along the ventral surface Hydrocele- accumulation of fluid around the testes Crytoorchidism- incomplete descent of testicle Hermaphroditism-both ovarian and testis present

Hydrocele : 

Hydrocele

Slide 40: 

Hydrometrocolpos- collection of fluid in the vagina and uterus Ovarian cyst- due to maternal hormone stimulation, may lead to a torsion

Hematocolpos : 

Hematocolpos

RENAL CYST : 

RENAL CYST Usually Not A Big Deal One Works As Good As Two Important to Assess After Birth For Function

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