2 congenital anomalies lower

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2 congenital anomalies lower

  1. 1. CONGENITAL ANOMALIESLOWER URINARY TRACTAhmad HannoProfessor and Head of Pediatric Urology
  2. 2. GeneralpractitionerSurgeonUrologistPediatric Urology
  3. 3. I. Urachal anomaliesII. HypospadiasIII. Posterior urethral valvesIV. Exstrophy – epispadiascomplex
  4. 4. URACHAL ANOMALIES
  5. 5. URACHAL ANOMALIES
  6. 6. HYPOSPADIAS Urethral meatus is ventral in location Meatus located proximal to the tip ofglans Prepuce is hooded Ventral curvature on erection
  7. 7. HYPOSPADIAS REPAIRStraightening of the penis “Orthoplasty”Extending the urethra to tip of the glans“Urethroplasty”Fashioning the new meatus “Meatoplasty”Refashioning the glans around neo-urethra“Glanuloplasty”Covering the neo-urethra with skin
  8. 8. POSTERIOR URETHRAL VALVES
  9. 9. POSTERIOR URETHRAL VALVESRemnant obstructing tissues at the distal endof posterior urethra in malesPrenatal infravesical obstructionHydroureteronephrosis, distended bladderand posterior urethraVesicoureteric refluxUrosepsisCommon cause of renal insufficiency
  10. 10. PRESENTATIONSPrenatal UltrasoundPostnatal– Obstructed urinary stream– Renal insufficiency– Failure to thrive– Urosepsis– Hydronephrosis– Full bladder
  11. 11. DIAGNOSIS USKey-hole signThick-walled distended bladder
  12. 12. DIAGNOSIS VCUG
  13. 13. MANAGEMENTStabilize the critically ill babyUrethral “feeding tube”Transurethral “fulguration” of the valvesVesicostomy if renal function is impairedDelayed managenent– Clean intermittent catheterization– Attention to reflux– Bladder augmentation– Renal Tx
  14. 14. TRANSURETHRAL FULGURATIONEndoscopic view
  15. 15. TRANSURETHRAL FULGURATIONFulguration Incision
  16. 16. EXSTROPHY – EPISPADIAS COMPLEXLack of development of the mesoderm of theinfra-umbilical regionDiastasis of the symphysis pubisBladder is opened to the outsideEpispadias in malesBifid clitoris in the femaleBilateral inguinal hernias are common
  17. 17. ABNORMAL BLADDER PLATE INTHE OLDER CHILD
  18. 18. SURGICAL REPAIRClosure of bladder plateComplete penile disassemblyRepair of epispadiasVentral re-location of the urethraRepair of the clitoris in femalesClosure of the abdominal defect• Simple closure in the first 72 hours• Bilateral iliac osteotomy thereafterAttention to continence at age 3 – 5 years

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