November 16, 2010

 Hydronephrosis  Hydroureteronephrosis  Pyelectasis  Pyelocaliectasis  Screening of fetus  Need postnatal U/S ◦ If not urgent 3-10 days  Allow increased urine production to fill out defects ◦ 20% resolution  f/u ultrasounds at several months and 1 year

On discharge examination of a female newborn infant, you notice a palpable mass in the right abdomen. An abdominal ultrasound reveals hydronephrosis. What is the next study that should be performed? A. IVP B. Cystoscopy C. VCUG D. Renal Scan E. No intervention at this time

 Postnatal hydronephrosis ◦ Complete radiographic eval  VCUG**  Rule out infravesical obstruction  VUR  Other  IV urography  True obstruction  Radionuclide scan  Function  Delay 4-6 weeks

 Males  Common cause of infravesical obstruction  Associated with ◦ Prenatal hydronephrosis ◦ UTI ◦ Incontinence ◦ Renal Failure ◦ Diminished urinary stream

 Neonates ◦ Pulmonary hypoplasia ◦ Renal failure ◦ Bladder distention ◦ Hydroureteronephrosis  Older children ◦ Incontinence ◦ Renal failure

 Diagnosis ◦ VCUG  Treatment ◦ Endoscopic fulguration ◦ Cutaneous vesicostomy  Smaller babies  Prognosis ◦ Renal dysplasia ◦ Bladder compliance  Worse prognosis if poorly compliant  Reflux and hydronephrosis will not improve

 33% preemies  3% Full term  Associated abnormalities ◦ Renal ultrasound  Urinary tract abnormalities are rare ◦ Hypospadias w/ unilateral cyptorchidism  Intersex anomalies - karyotype ◦ Bilateral nonpalpable testes  Endo eval  FSH, LH, testosterone  Treatment ◦ Correction at 6-12 months  Could resolve on its own during this time ◦ Cancer and Fertility risk

 AKA Eagle-Barrett Triad  Boys  1/35,000-50,000  Triad ◦ Abnormal abdominal musculature ◦ Abdominal cryptorchidism ◦ Floppy dysmorphic urinary tracts  VUR

 Other findings ◦ Megalourethra ◦ Prostatic hypoplasia ◦ Dimples on lateral knees ◦ GI ◦ Cardiac  Risks ◦ UTI with sepsis  Careful catheterization  Prognosis ◦ Renal dysplasia

A mother brings her infant into the office because she has noticed a continual drainage from her umbilicus. You suspect a patent urachus. You explain to the mother that this results from an abnormal communication between... A. The bladder and umbilicus B. A ureter and the umbilicus C. The small intestine and the umbilicus D. The renal pelvis and the umbilicus E. The colon and the umbilicus

 Bladder dome to umbilicus ◦ Vestigial structure  Persistence ◦ Patent urachus ◦ Vesicourachal diverticulum ◦ Urachal cyst ◦ Urachal sinus  Dx ◦ U/S ◦ CT  Tx ◦ Excision  Source of carcinoma in adults

 Patent ◦ Communication remains ◦ Umbilical drainage ◦ Inflammation ◦ Infection  Urachal cysts ◦ Infection ◦ Adulthood  Suprapubic or infraumbilical pain, tenderness, palpable mass or abdominal wall inflammation

 UPJ Obstruction ◦ Presentation  Antenatal hydronephrosis  Neonatal flank mass  UTI  Recurrent abdominal pain  Co-existing VUR

 UPJ Obstruction ◦ Dx  U/S  IVP  Retrograde pyelography*  VCUG  Coextisting VUR  Renal scan  True obstruction

 Megaureter ◦ Large ureter with or without intrarenal hydronephrosis ◦ Causes  VUR  Ureterovesical obstruction  Local neurologic or muscular abnormality  Nonobstructive*

 Megaureter ◦ Discovery  Antenatal U/S  UTI ◦ Treatment  Some resolve spontaneously  Obstructive  Excision and reimplantation

After palpating a left sided mass at a well visit in a 2 month old, a renal ultrasound shows that your patient has a multicystic dysplastic kidney. A renal scan of this dysplastic kidney is most likely to show... A. Full function B. No function C. 50% function D. 25% function E. 75% function

 2 nd most common cause of renal enlargement in neonates  Discovery ◦ Antenatal U/S ◦ Abdominal mass  Dx ◦ U/S  Enlarged kidney with non- communicating cysts ◦ Renal scan  Multicystic kidneys rarely function

 Treatment ◦ VCUG  Contralateral VUR  UPJ obstruction, PUV, megaureter and duplication ◦ Long term F/U  15% involute  Prognosis ◦ Low risk  HTN  Infection  Malignancy

 Usually benign  Usually incidental finding  Evaluation ◦ U/S ◦ CT ◦ Cyst aspiration if suspicious  DDx ◦ Cystic Wilms tumor ◦ Multilocular cystic dysplasia ◦ Duplication anomaly with hydronephrosis ◦ Calyceal diverticulum ◦ Adult polycystic disease