Uro- Congenital/acquired urologic abnormalities

What is Vesicoureteral reflex (VUR)?

abn backward (retrograde) flow of urine from the urinary bladder into the upper urinary tract during voiding

What is the most prevalent urological abnormality in neonates?

VUR

What are RF of VUR?

caucasians, F > M, genetic predisposition, prenatal hydronephrosis

What are features of VUR?

asx or associated w/ bowel/bladder dysfunction: bladder overactivity, urgency, hypoactive bladder, chronic constipation, encopresis

What is the gold standard test for VUR?

voiding cystourethrogram (VCUG) w/ direct cystography

What workup is needed for VUR?

UA, labs, renal US, tech99 renal imaging, VCUG

What grade VUR:

reflux into non-dilated ureter

Grade I

What grade VUR:

reflux into both ureter and renal pelvis w/o dilation

Grade II

What grade VUR:

reflux w/ a mildly dilated ureter and pyelocaliceal system or mild blunting of the calyces

Grade III

What grade VUR:

reflux w/ a somewhat tortuous, mild to moderately dilated ureter w/ blunting of renal calyces w/ preservation of the renal papilla

Grade IV

What grade VUR:

reflux involving very tortuous, severely dilated ureter and pyelocaliceal dilatation and no visual of renal papilla

Grade V

What is the tx for grades I&II VUR?

75-80% w/ spontaneously resolve by age 5

What is the tx for VUR grades III & IV?

if u/l and dx < 2yo, may spontaneously resolve

• abx prophylaxis to prevent UTI

• renal US q6-12 months

• repeat VCUG q1-2 yrs

• routine BP monitoring

What is Cryptorchidism?

absence of at least one testicle from the scrotum

What are RF for cryptorchidism?

EtOH during pregnancy, cigarette smoking, congenital malformations, phthalate exposure, FH, ibuprofen or cosmetic use, preeclampsia, etc

What are features of cryptorchidism?

absence of palpable scrotal testicle, dec scrotal rugae, infertility, ± inguinal hernia

When is a scrotal US warranted to evaluate cryptorchidism?

nonpalpable testis

What is the tx for cryptorchidism?

surgical → orchiopexy

indicated for pts btwn 6-18 months

What is a cystocele?

chronic condition during which the bladder herniates to the ant. vaginal wall; result from weakness in the pelvic floor support system

What are RF for a cystocele?

obesity, inc age, parity, collagen abnormality, FH, hx of pelvic surgery

What are features of a cystocele?

vaginal pressure, urinary sx, sexual dysfunction, constipation, incomplete emptying

What is the tx for a cystocele?

observation if asx w/ low grade cystocele

conservative: pessaries or kegels

surgical: ant. colporrhaphy or sacral colpopexy

What is a urethral prolapse?

uncommon condition characterized as urethral mucosal bulging seen in prepubertal girls and postmenopausal women

What are RF for a urethral prolapse?

pelvic floor weakness, pregnancy/childbirth, inc intrabdominal pressure, pelvic surgery

What are features of a urethral prolapse?

pain at urethral opening, painful urination, tenderness, bleeding

What is the tx for a urethral prolapse?

topical estrogen cream, sitz baths, surgical if severe

What is a urethral stricture?

abn narrowing of the urethra, typically caused by scar tissue, leading to obstructive urinary sx; MC idiopathic

What are RF for a urethral stricture?

males > 65yo, AA, hx trauma or injury, indwelling catheter

What are features of a urethral stricture?

weak stream, straining, incomplete bladder emptying, double voiding, intermittency, post-void dribbling, frequent UTIs, dysuria

What is the gold standard test for dx urethral stricture?

retrograde urethrogram

What is the preferred initial test for dx urethral stricture?

uroflowmetry

*low peak flow (<12)

What is the tx for a urethral stricture?

urethral dilation, surgical interventions (urethrotomy, urethroplasty, urethral balloon dilation)

What is nephrolithiasis?

renal stones formed w/in the kidneys

What is urolithiasis?

stones in the ureters, bladder, or urethra

What are the majority of stones composed of?

80% Ca oxalate or phosphate

less common: uric acid, struvite, cystine

What are RF for urolithiasis?

dehydration, diet, FH, hx bypass, CKD, HTN, gout, DM

What are the MC areas for a stone obstruction?

ureteropelvic junction, mid ureter where it crosses the iliac vessels, ureterovesical junction

What are features of urolithiasis/nephrolithiasis?

sudden/graudal pain, u/l colicky abd/flank pain, hematuria, N/V, fevers

What test for urolithiasis is preferred in peds and pregnant pts?

renal US

What is the study of choice for urolithiasis?

CT abd/pelvis w/o contrast

What is the tx for urolithiasis?

NSAIDs, antiemetics

stone 2-7 mm: medical expulsive therapy (MET) - alpha block (tamsulosin), hydration, pain control

large stones or severe sx: STAT uro consult, surgery -shockwave lithotripsy, ureteroscopy w/ stent, nephrolithotomy

What can help w/ long-term management of pts w/ calcium urolithiasis?

potassium citrate, thiazide diuretics, low Na diet, inc fluid intake, inc Ca, limit oxalate-rich foods (berries, spinach, beets, nuts, citrus, rice)