Congenital anomalies of the ureter

Congenital anomalies of the ureter

Clinical feature
Male:femal 3:1 Left kidney more than right Antenatal diagnosis by ultrasound Neonatal diagnosis depend on ultrasound examination Older children may present with fever , UTI, loin mass and failure to thrive
Diagnosis
•Abdominal ultrasound show hydronephrosis without ureteric ureteric dilatation •IVU show hydronephrosis , boxing sign., complete cut of ureter and faint secretion of the dye •CT SCAN •RADIOISOTOPES SCAN especially used for detection percentage of renal damage

Treatment
•Open pyeloplasty •Laparscopic pyeloplasty •Antegrade endopyelotomy •Retrorade endopyelotomy

Vesicoureteric reflux
•Vesicoureteral reflux (VUR) is a condition in which urine flows retrograde, or backward, from the bladder into the ureters/kidneys. Urine normally travels in one direction (forward, or antegrade) from the kidneys to the bladder via the ureters, with a 1-way valve at the ureterovesical (ureteral-bladder) junction preventing backflow. The valve is formed by oblique tunneling of the distal ureter through the wall of the bladder, creating a short length of ureter (1–2 cm) that can be compressed as the bladder fills. Reflux occurs if the ureter enters the bladder without sufficient tunneling,

Secondary VUR
•Bldder outlet obstruction e.g posterior uretheral valve •Congenital Neurogenic bladder
Grading
Clinical feature
•Most children with vesicoureteral reflux are asymptomatic. Vesicoureteral reflux may be diagnosed as a result of further evaluation of prenatal hydronephrosis or hydroureter (abnormal widening of the ureter), as well as reflux in a sibling (routine testing in either circumstance is controversial). Reflux also increases risk of urinary tract infection or acute pyelonephritis, so testing for reflux may be performed after a child has one or more infections.
•In infants, the signs and symptoms of a urinary tract infection may include only fever and lethargy, with poor appetite and sometimes foul-smelling urine, while older children typically present with dysuria and frequent urination
Diagnosis
•An abdominal ultrasound might suggest the presence of VUR if ureteral dilatation is present; however, in many circumstances of VUR of low to moderate severity, the sonogram may be completely normal, thus providing insufficient utility as a single diagnostic test in the evaluation of children suspected of having VUR, such as those presenting with prenatal hydronephrosis or urinary tract infection (UTI).
•VCUG (voiding cystourethrography) is the method of choice for grading and initial workup, •. A high index of suspicion should be attached to any case where a child presents with a urinary tract infection, and anatomical causes should be excluded