198 Congenital GU anomalies Flashcards
What is the most likely cause of congenital GU anomalies that are found on prenatal ultrasounds and persist after birth?
ureteropelvic junction obstruction
antenatal urinary tract dilation is the most common self-resolving cause
What is a common cause of recurrent UTIs in children?
vesicoureteral reflux
What is the management for vesicoureteral reflux?
prevention of further UTIs and renal scarring
can treat with prophylactic antibiotics and correction of bowel and bladder dysfunction
What is the most common cause of bladder outlet obstruction in boys?
posterior urethral valve
When should you intervene to correct undescended testes?
after 6 months
testes rarely descend spontaneously after 6 months of age and require surgical correction
A 28 yo pregnant woman is seen as a consultation for prenatally-detected urinary tract dilation. The most likely diagnosis is:
a) vesicoureteral reflux
b) ureteropelvic junction obstruction
c) ureterocele
d) multicystic dysplastic kidney
e) a benign condition that will resolve on its own
e) a benign condition that will resolve on its own
50-80% of all antenatal hydronephrosis will resolve on its own
A 14 year old boy presents with intermittent flank pain for the past 2 months. Ultrasound and MAG-3 diuretic renogram are suspicious for a ureteropelvic junction obstruction. The most likely etiology is:
a) adynamic ureteral segment
b) fibroepithelial polyp
c) a crossing vessel
d) a high insertion of the ureter into the pelvis
e) an intrinsic narrowing at the ureteropelvic junction
c) a crossing vessel
- the intermittency of his symptoms most likely represents an intermittent UPJ obstruction - crossing vessel is the most common etiology of an intermittent UPJ obstruction*
- choice A, D, and E are associated with asymptomatic or constant obstruction; choice B is a very rare cause*
Orichiopexy for an undescended testis discovered at birth should be performed at:
a) the time of discovery
b) 3 months of age
c) 6 months of age
d) 7 years of age
e) puberty
c) 6 months of age
it is unlikely to spontaneously resolve at this point, waiting longer poses risk to spermatogonia
A 5 yo girl presents after a febrile UTI. To determine whether vesicoureteral reflux is present, the diagnostic imaging study that should be performed is:
a) VCUG
b) Mag 3 diuretic renogram
c) CT scan of the abdomen and pelvis
d) cystoscopy
e) renal and bladder ultrasound
a) VCUG
a voiding crystourethrogram is the gold standard for diagnosing vesicoureteral reflux
What is the most common cystic disease of childhood?
multicystic dysplastic kidney
diagnosis made on prenatal ultrasound, associated with contralateral vesicoureteral reflux and ureteropelvic junction obstruction
What is the most common intrinsic cause of ureteropelvic junction obstruction?
adynamic ureteral segment
What is the most common extrinsic cause of ureteropelvic junction obstruction?
crossing vessel at an accessory lower pole renal artery
What is the most common cause of renal scarring in children?
vesicoureteral reflux
What is the Weigert-Meyer rule?
a rule to predict pathology of ureteral duplications which states that the ureter associated with the lower pole of the kidney inserts more laterally and refluxes while the ureter of the upper pole that inserts more medially will obstuct
What are ureteroceles?
saccular dilation of the distal ureter with variable presentation and complication
