Pediatric Urology

Posted by e-Medical PPT Wednesday, January 18, 2012
Renal agenesis
Bilateral
 Pulmonary hypoplasia-oligohydramnios
 Facial changes “Potter’s facies”
 Limb anomalies
Unilateral
 1 in 1100 births
 Abnormality of ureteral bud rather than metanephros
 Unilateral adrenal present, abnormality of other mesonephic duct structures (vas deferens)

Anomalies of Form and Fusion
Horseshoe kidney is most common fusion anomaly
4-6th week gestation
1 in 400
Ureter, kidney tend to be normal

Horseshoe Kidney
Common to have other congenital anomalies
 Skeletal, cardiovascular, neural tube defects, anorectal
 UPJ obstruction, stones, UTI, hypospadius, cryptorchidism
 ? higher chance of renal cancer (Wilm’s)

Multicystic Dysplastic Kidney
 Most common type of renal cystic disease
 Most common cause of abdominal mass in an infant
 Bunch of grapes
 No functioning renal tissue
 Atretic ureter
 Tend to involute through childhood
 Higher rate of contralateral renal anomalies
 UPJO, vesico-ureteric reflux
 Slight but definite risk of Wilm’s tumor

Antenatal Hydronephrosis:UPJ Obstruction
UPJO represents a relative narrowing of the proximal ureter impeding drainage
Pain, hematuria, UTI or a flank mass in a child or young adult
~ 1/3 kidneys deteriorate and/or develop complications which require surgery

Antenatal Hydronephrosis
Differential diagnosis
UPJ obstruction
Vesico-ureteric reflux
MCDK
Posterior urethral valves
UVJ obstruction
Primary megaureter
Ectopic ureter
Transient hydronephrosis

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