The Fetal Genitourinary System (lesson 19b)

Question 1

By how many weeks gestation can the kidneys be identified and thoroughly evaluated?

Answer 1

22 weeks

Question 2

Does fetal voiding decrease or increase bladder size?

Answer 2

Decrease

Question 3

How often does the fetal bladder void?

Answer 3

Once per hour

Question 4

What can help rule out bilateral renal dysfuction or agenesis, bilateral renal or ureteral obstruction?

Answer 4

Bladder filling, as it shows at least one kidney is doing its thing

Question 5

By which weeks does fetal urine make up 90% of amniotic fluid?

Answer 5

20 wks

Question 6

If oligiohydramnios is present after 16 weeks gestation, what is this suspicious for?

Answer 6

Malfunctioning GU system, because if baby’s not peeing, then something is up with the GU (geniturinary) system

Question 7

What is the recurrence rate of renal agenesis in families?

Answer 7

50%

Question 8

Unilateral agenesis is often correlated with which urinary tract anomalies of the contralateral kidney?

Answer 8

UPJ, VUR

Question 9

In the case of unilateral agenesis, what happens to the single kidney?

Answer 9

Compensatory hypertrophy

Question 10

Does unilateral agenesis result in a change in amniotic fluid or bladder filling?

Answer 10

No, it does not affect the amniotic fluid

Question 11

What are some of the differential diagnoses for an empty renal fossa?

Answer 11

renal aplasia, renal dysplasia, multicystic dysplastic kidney, renal ectopia

(a.d.m.e.)

Question 12

What anomalies have an increased incidence in association with renal ectopia?

Answer 12

Hydronephrosis and VUR, UTIs, and renal stones

Question 13

What’s the most common location for an ectopic kidney?

Answer 13

Pelvis

Question 14

What are the most common crossed renal ectopia?

Answer 14

Left to right crossover; upper pole of crossed ectopic kidney latches onto the lower pole of the normal kidney

Question 15

What are some ultrasound findings that occur with crossed renal ectopia?

Answer 15

Calyceal dilation and hydronephrosis

Question 16

What is a renal isthmus?

Answer 16

The connection between the two renal masses during a horseshoe kidney

Question 17

What is the most common renal fusion anomaly?

Answer 17

Horseshoe kidney

Question 18

What makes a MILD degree of hydronephrosis in SECOND trimester?

Answer 18

4 to < 7 mm

Question 19

What makes a MODERATE degree of hydronephrosis in SECOND trimester?

Answer 19

7 to ≤ 10 mm

Question 20

What makes a SEVERE degree of hydronephrosis in SECOND trimester?

Answer 20

> 10 mm

Question 21

What makes a MILD degree of hydronephrosis in THIRD trimester?

Answer 21

7 to < 9 mm

Question 22

What makes a MODERATE degree of hydronephrosis in THIRD trimester?

Answer 22

9 to ≤ 15 mm

Question 23

What makes a SEVERE degree of hydronephrosis in THIRD trimester?

Answer 23

> 15 mm

Question 24

What is one of the most common fetal uropathy anomalies detected on prenatal sonography?

Answer 24

Obstruction

Question 25

What type of dilation is more common in fetuses with trisomy 21?

Answer 25

Pelvic dilation

Question 26

What measurement are most kidneys with antenatal hydronephrosis normal at birth with? (answer in mm)

Answer 26

10 mm

Question 27

When is a follow up ultrasound done when hydro is detected in the second trimester?

Answer 27

32 weeks

Question 28

What is one of the key factors in determining postnatal pathology? (fluid related)

Answer 28

Oligio

Question 29

What is APRPD?

Answer 29

Anterior posterior renal pelvic diameter; the renal pelvis measured

Question 30

What is the most common cause of congenital obstructive hydronephrosis?

Answer 30

UPJ, ureteropelvic junction obstruction

Question 31

What is the typical sonographic appearance of UPJ?

Answer 31

Severe unilateral hydronephorsis without ureteral dilation, and normal bladder

Question 32

What is UVJ Obstruction?

Answer 32

Ureterovesical junction obstruction; hydro and dilatation of he ureter to the level of the bladder, without dilated bladder

Question 33

What is the measurement for megaureter?

Answer 33

Greater than 7mm from 30wks onwards

Question 34

What type of obstruction is most common in females?

Answer 34

Ureterocele

Question 35

What is a ureterocele most commonly associated with?

Answer 35

Duplicated renal collecting systems

Question 36

Ureteroceles found outside the bladder may simulate what?

Answer 36

Any pelvic cystic mass, ovarian cyst, anterior meningocele, or hydrocolpos

Question 37

An enlarged bladder (megacystis) and bilateral hydronephrosis characterizes what type of obstruction?

Answer 37

Lower urinary tract obstruction (LUTO)

Question 38

What are the two most common causes of LUTO?

Answer 38

PUV and urethral atresia

Question 39

Urethral atresia is characterized by what?

Answer 39

Anhydramnioas and a largely distended bladder that fills the entire abdo and pelvis

Question 40

What is the 'keyhole sign' associated with?

Answer 40

PUV (posterior urethral valves)

Question 41

What is the least common type of PUV?

Answer 41

Type II: vertical of longitudinal folds between the verumontanum and prox prostatic urethra bladder neck

Question 42

What is the most common type of PUV?

Answer 42

Type I: anterior fusing of the plicae colliculi, mucosal extending from the bottom of the verumontanum distally along the prostatic and membranous urethra

Question 43

Prune belly syndrome is four times more common in what types of twins?

Answer 43

Monozygotic and dizygotic

Question 44

What is the triad for Prune Belly Syndrome?

Answer 44

Distension of the anterior abdominal wall, obstruction of urinary tract, and bilateral cryptorchidism

Question 45

What are the hereditary polycystic kidney diseases?

Answer 45

ARPKD (autosomal recessive) & ADPKD (autosomal dominant)

Question 46

What are the nonhereditary polycystic kidney diseases?

Answer 46

MCDK (multicystic dysplastic kidneys)

Question 47

What are the four types of ARPKD?

Answer 47

Perinatal, neonatal, infantile, and juvenile PNIJ - J most popular

Question 48

What is the leading cause of perinatal death?

Answer 48

Pulmonary hypoplasia related to oligiohydramnios

Question 49

What is the most common inherited kidney disease?

Answer 49

ADPKD

Question 50

Is MCDK typically unilateral or bilateral?

Answer 50

Unilateral

Question 51

With MCDK, contralateral renal anomalies are a common finding - what is the most common renal anomaly found?

Answer 51

VUR

Question 52

With MCKD, will the lungs develop normally?

Answer 52

Yes, as amniotic fluid level is not affected

Question 53

In cases of PUV, urethral atresia, or UPJ obstruction, what type of kidney disease is most common?

Answer 53

Obstructive Cystic Dysplasia

Question 54

Are simple renal cysts something to worry about, when on their own?

Answer 54

No

Question 55

Renal tumours occur in which trimester?

Answer 55

Exclusively third trimester

Question 56

Renal tumours are associated with what?

Answer 56

Polyhydramnios and subsequent premature labor

Question 57

Adrenal glands are best visualized in which trimester?

Answer 57

Third trimester (but can be seen in the second trimester)

Question 58

Is the prognosis of fetal neuroblastoma a good one if detected?

Answer 58

Yes, as these blastomas can spontaneously regress and do not require aggressive intervention

Question 59

What does the bony pelvis consist of?

Answer 59

Iliac crests (echogenic) separated from the sacrum (echogenic) by the sacroiliac joint (hypoechoic)

Question 60

What are the two major abnormalities in the pelvis?

Answer 60

Internal pelvic masses and sacrococcygeal teratomas

Question 61

What are the most common urachal anomalies?

Answer 61

Urachal sinus and urachal cyst

Question 62

If the bladder appears as a solid anterior abdominal wall mass, what can it be?

Answer 62

Bladder exstrophy

Question 63

Bladder exstrophy can also look like what other two abnormalies?

Answer 63

Omphalocele or gastroschisis

Question 64

What are some other diagnostic criteria for bladder exstrophy? (3)

Answer 64

Splayed iliac bones, epispadias, and small genitals

Question 65

What are the sonographic findings of cloacal exstrophy?

Answer 65

Absent bladder, large midline infraumbilical anterior wall defect, omphalocele, and lumbosacral anomalies (myelomeningocele)

Question 66

What is the OEIS complex?

Answer 66

Omphalocele, exstrophy of the bladder, imperforate anus, spinal anomalies (also known as cloacal exstrophy)

Question 67

Which weeks are the genital tubercle in males and females indistinguishable?

Answer 67

Weeks 12-14

Question 68

Downward angle of the tubercle indicates which sex?

Answer 68

Female

Question 69

Upward angle of the tubercle indicates which sex?

Answer 69

Male

Question 70

Are the normal ovaries, uterus, and vagina are typically seen within the fetus?

Answer 70

Yes, true.

Question 71

What is hypospadias?

Answer 71

The abnormal development of the corpus spongiosum and cavernosa urthera due to incomplete fusion of urogenital folds.

Question 72

What can be seen with hypospadias? (think balls)

Answer 72

Bifid scrotum

Question 73

When does testicular descent occur abdominally?

Answer 73

10-15 wks gestation

Question 74

When does testicular descent inguinally?

Answer 74

26-25 wks gestation

Question 75

From what week can bilateral testicular descent be observed?

Answer 75

32 wks

Question 76

Is it normal for a variable amount of fluid remaining from testicular descent into the scrotum to surround the testes?

Answer 76

Yes, normal

Question 77

What can crypotorchidism be associated with?

Answer 77

Noonan syndrome, Klinefelter syndrome, multiple congenital anomalies, and masculinization of female genitalia

Question 78

What might it mean if a hydrocele keeps enlarging?

Answer 78

A continued patency of the processus vaginalis

Question 79

What could increasing scrotal volume indicate?

Answer 79

Inguinoscrotal hernia

Question 80

What side do inguinoscrotal hernias most commonly occur on?

Answer 80

The right side

Question 81

What are the most common intraabdominal tumours in female fetuses and neonates?

Answer 81

Fetal ovarian cysts

Question 82

What may cause a fetal ovarian cyst to develop? (3)

Answer 82

Maternal hormonal stimulation, hypothyroidism, or diabetes

Question 83

When are fetal ovarian cysts typically seen?

Answer 83

Third trimester

Question 84

At what size do fetal ovarian cysts start to become worrisome for torison?

Answer 84

5cm

Question 85

What is hydrocolpos/hydrometrocolpos?

Answer 85

Hydrocolpos - cystic dilatation of vagina Hydrometrocolpos - cystic dilatation of vagina and uterus

Question 86

How will you see hydrocolpos/hydrometrocolpos on ultrasound?

Answer 86

Midline anechoic or hypoechoic mass posterior to the bladder, can compress lower ureters

Question 87

What are poor prognostic signs with hydrocolpos?

Answer 87

Associated renal dysplasia, oligohydramnios, fetal ascites, and resultant pulmonary hypoplasia

Question 88

What does 'disorders of sex development' mean?

Answer 88

A congenital condition in which development of chromosomal, gonadal, or anatomical sex is atypical.

Question 89

What is AIS?

Answer 89

(Androgen insensitivity syndrome) Results in a normal female phenotype but amenorrhea presents at puberty and testes may be found