URINARY TRACT OBSTRUCTION Posterior Urethral Valves 1/50 000 most common obstructive urethral lesion in male infants muco...
URINARY TRACT OBSTRUCTION
Posterior Urethral Valves
- 1/50 000 most common obstructive urethral lesion in male infants
- mucosal folds at the distal prostatic urethra
- presents with obstructive symptoms, UTI, flank masses, urinaryascites if renal pelvis ruptures
- now detected antenatally: hydronephrosis, pulmonary hypoplasia
- Diagnosis: U/S, VCUG
- Treatment: destruction of valves
UPJ Obstruction
- most common ureteric abnormality in children
- usually in boys, on the left (10-15% bilateral)
- Etiology: segment of ureter lacking peristaltic activity,congenital narrowing, muscular bands, external compression
- Diagnosis: U/S, renal scan +/– furosemide
- Surgical correction with good prognosis
VESICOURETERAL REFLUX (VR)
- urine flows back from the bladder into the ureter, kidney; common
- 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 - symptoms of
• urinary tract infection, pyelonephritis
• renal failure (FTT, uremia, hypertension) rare - diagnosis with U/S, VCUG; tc-DMSA to assess renal scarring
- 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 - Complications: pyelonephritis, recurrent UTI, reflux nephropathy,hypertension, end stage renal disease
- 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
