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URINARY TRACT OBSTRUCTION and VESICOURETERAL REFLUX (VR)

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URINARY TRACT OBSTRUCTION

Posterior Urethral Valves

 

  1. 1/50 000 most common obstructive urethral lesion in male infants
  2. mucosal folds at the distal prostatic urethra
  3. presents with obstructive symptoms, UTI, flank masses, urinaryascites if renal pelvis ruptures
  4. now detected antenatally: hydronephrosis, pulmonary hypoplasia
  5. Diagnosis: U/S, VCUG
  6. Treatment: destruction of valves


UPJ Obstruction

 

  1. most common ureteric abnormality in children
  2. usually in boys, on the left (10-15% bilateral)
  3. Etiology:  segment of ureter lacking peristaltic activity,congenital narrowing, muscular bands, external compression
  4. Diagnosis: U/S, renal scan +/– furosemide
  5. Surgical correction with good prognosis


VESICOURETERAL REFLUX (VR)

 

  1. urine flows back from the bladder into the ureter, kidney; common
  2. pathophysiology
    • most commonly due to short tunnel of ureter in wall of bladder
    • 30-50% of those with myelomeningoceles, by association with neurogenic bladder
    • secondary to bladder obstruction
  3. symptoms of
    • urinary tract infection, pyelonephritis
    • renal failure (FTT, uremia, hypertension) rare
  4. diagnosis with U/S, VCUG; tc-DMSA to assess renal scarring
  5. Staging by VCUG
    I   - ureters only fill
    II  - ureters and pelvis fill
    III - ureters and pelvis fill, some dilatation
    IV - ureters, pelvis and calices fill, significant dilatation
    V - ureters, pelvis, and calices fill, major dilatation and tortuosity
  6. Complications: pyelonephritis, recurrent UTI, reflux nephropathy,hypertension, end stage renal disease
  7. Management: keep urine sterile to prevent renal damage
    • Stage I-III: more than 80% resolve with time
    • observe with repeat VCUG, U/S, urine cultures
    • monitor renal function
    • prophylactic antibiotics (TMP/SMZ, nitrofurantoin)
    • Stage IV and greater —> surgical intervention
URINARY TRACT OBSTRUCTION and VESICOURETERAL REFLUX (VR) URINARY TRACT OBSTRUCTION and VESICOURETERAL REFLUX (VR) Reviewed by Radiology Madeeasy on October 05, 2010 Rating: 5
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