Congenital Anomalies of Kidney & Ureter pptx - عماد حسن

Congenital anomalies of the kidney and ureter

EMAD HASAN MAHMOOD
PROFESSOR OF UROLOGY

Learning objectives

1-enlist congenital abnormalities of the kidney and ureter
2-describe clinical significance of these abnormalities what are symptoms and complications
3-enlist diagnostic investigations plan
4-suggest treatment plan

Types of renal abnormalities

1-number
2-size
3-position
4-rotation
5-fusion

Congenital abnormalities of renal pelvis and ureter

1-pelviureteric junction obstruction
2-ureteric duplications
3-ureterocele
4-congenital vesicoureteric reflux
5-megaureter
6-retrocaval ureter
7-ectopic ureter

diagnosis

A-antenatal U/S ( 18-20 )include following severity , unilateral versus bilateral , renal parenchyma thin, bladder abnormalities , amniotic fluid
B-postnatal physical examination , palpable bladder
USG , IVU , MCU , DIURETIC ISOTOPES

hydronephrosis
Aseptic dilatation of renal pelvis and collecting system
0.6-4.5% antenatal U/S
Several grading system (renal pelvic diameter)
Antenatal U/S
Causes
Transient , physiological , PUJ Ob. , VUR , Megaureter , Ureterocele , PUV

CONGENITAL PUJ OB

Etiology
Aperistaltic segment of ureter due to absent muscle
Crossing vessel over PUJ
Valve
High insertion of ureter
Stenosis
stricture

INCIDENCEMOST COMMON KIDNEY OBSTRUCTION IN CHILDRENOCCUR IN 1 IN 500 TO 1 IN 1250

Management of UPJ obstruction

Radiological Diagnosis
Abdominal U/S show various degree of hydronephrosis and ureter not dilated and evaluate parenchymal thickness
IVU same finding of U/S in addition evaluate function of the kidney
Abdominal CT with contrast same finding of IVU in addition if kidney not visualized by IVU can bee seen by CT
Radioisotopes scan ( MAG 3 ) evaluate the degree of obstruction in addition the split functio of the kidney

Urinanalysis may show RBC, WBC

Serum urea and creatinine to evaluate renal function especially in bilateral obstruction

Treatment is surgical PYELOPLASTY either dimembered example (Anderson-Hynes ) OR non dismembered example vertical flap (Culp- Scardino ) OR spiral flap

DUPLICATIONS

Renal pelvis
Common usually unilateral
Upper pelvis is small drain upper calyx
Treatment if Asymptomatic no treatment if one severe damage is partial nephrectomy

DUPLICATIONS
URETER
Often join together before reaching bladder or may be complete and open independently in the bladder the ureter of upper moiety opens
distal and medial to its fellow and suffer ureterocele or VUR OR ECTOPIC
COMPLICATIONS REPEATED UTI OR STONE FORMATION
TREATMENT
Asymptomatic no treatment if complications treaTment is accordingly