1. Congenital anomaly of urinary system dr.mohamed fawzi alshahwaniة
Congenital anomaly of urinary system dr.mohamed fawzi alshahwani

2. Congenital abnormalities of the kidney
Its relatively uncommon
Usually symtomless
if symptomatic its due to
infection
stone
hydronephrosis
Often discovered by accident

3. Anomalies of number Bilateral renal agenesis not compatible with life
Unilateral renal agenesis
asymptomatic
Accidentally discovered
association with other anomalies

4. Anomalies of position Ectopia Pelvic lumber Rarely thoracic
40% symptomatic, association with other anomalies

5. Ectopic kidney

6. Thoracick kidney

7. Lumber ectopic kidney \

8. Crossed ectopia :
Non fused
Fused

9. Cross ectopia
Non fused

11. Horse shoe kidney The commonest fusion anomalies
1/3rd of cases are symptomatic
Symptoms related to:
Infection
Stones
Hydronephrosis
Diagnosis:
May be palpable, US, IVU. MRI

12. Horse shoe kidney

13. Horse shoe normal

14. treatment Treat, Infection stone hydronephrosis
Division of the esthmus is only indicated in the course of surgery for abdominal aortic aneurysm

15. Parenchymal anomalies
Hypoplasia ..small kidney
Dysplasia:
Cystic dysplasia
Polycystic renal disease:
Infantile
Adult

16. dysplasia

17. \ \

18. Polycystic kidney A. infantile type Autosomal recessive US diagnosis
Early renal failure
incompatable with life
causing obstructed labour

20. Adult polycystic renal disease
The most common renal cystic disease Autosomal dominant
Progressive bilateral cystic degeneration

21. Adult polycystic renal disease

23. Clinical presentation
Positive family history
Loin pain before the development of renal mass
Hypertension, hematuria, renal mass
Associated liver cystic disease may be seen
Renal failure Usually in the early fifty

24. Imaging
Ultra sound is diagnostic
Ivu:
MRI
CT scan

25. Treatment Medical management of renal failure
Surgery : ( cyst puncturing)
Renal stone
Cyst infection
Hemorrhage in the cysts
Ureteric obstruction by cyst
Definitive treatment, renal transplantation

26. Simple renal cyst Solitary renal cyst Blue domed cyst
Unilocular , Avascular,smooth, clear fluid content
Mostly asymptomatic
Large cyst may be felt as a mass
Incidental finding on US or other imaging
renal cell carcinoma should be ruled out

29. Treatment Reassurance and follow up If symptomatic..
Rovsing operation : Deroofing by open surgery or laparoscopicaly

30. Anomalies of the collecting system
Bifid pelvis
Hydrocalicosis
Calycial diverticulum
Your Text Here

31. Bifid renal pelvis

32. Ureteral anomalies Duplication : Partial Complete Ectopic ureter
Ureterocele: Orthotopic
Ectopic
Pelviureteric junction obstruction
Congenital mega ureter
Retrocaval ureter

33. MRI:
Partial duplication

34. Complete ureteral duplication and ectopic ureteric orifice.

35. IVU:
ureteric duplication

36. Clinically asymptomatic unless complicated Diagnosis: US. IVU. CT scan
Clinically asymptomatic unless complicated Diagnosis: US. IVU . CT scan . MCU treatment: Only when symptomatic

37. Simple : in normally placed uretric orifice
Ureterocele A cystic dilatation of the intravesical sub mucosal part of the ureter
Simple : in normally placed uretric orifice
Ectopic : In lower position placed ureteric orifice , or with ureteric duplication

39. Ureterocele involving single system

41. Diagnosis
uls
IVU
MCU
Cystourethroscopy

42. Ureterocel: U/S

43. Ureterocele copra head appearance by IVU

44. treatment In simple ureterocele: in functioning kid,
excision & reimplantation
If non functioning kidney,,,nephrectomy
In ectopic :if single
As in simple ureterocele

45. Ureteropelvic junction obstruction
Primary : congenital
Secondary : to refluxing ureter

46. Mechanism of obstruction
Intrinsic smooth muscle pathology.
Adynamic segment
Congenital segmental stenosis
Mucosal valve , web , folds
Over riding an aberrant vessel

48. Clinical presentation
Abdominal mass
Episodic flank pain
Pain & fever when infected
The aggravating factors:
Cold, diuresis , fluid over intake

49. Diagnosis US IVU Diuretic IVU , Diuretic renography
Renal DMSA scan ( functional).
Retrograde pyelography

50. IVU: PUJO

51. pujo

52. Treatment Conservative Treat the pain ,infection and follow up
Indication of surgery
Recurrent attack of pain,
stone,
rogressive hydronephrosis

53. Surgery Pyeloplasty, by open surgery or laparoscopic pyeloplasty
Underson hynes
Culp
Scardino
V-Y plasty

54. Treatment,cont
Endoscopically
antegrade or retrograde endopyelotomy

55. Endopyelotomy

56. Postcaval ureter

58. Post caval ureter

59. Treatment Surgery if causing obstruction and pain
By resection of post caval segment and reanastomose the ureter in front of the IVC

60. Congenital mega ureter
Functional obstruction of lower end of the ueter leading to a progressive dilatation
Uni or bilateral
Diagnose by IVU
Treatment is by reimplantation