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CONGENITAL GENITO URINARY DISORDERS.pptx
- 2. introduction Disorders of kidney and urinary tract are commonly seen in pediatric units as medical and surgical problems. Incidence: 3 to 6 per 1000 live births
- 4. Congenital abnormalities of the kidney and urinary tract â«These problems usually required surgical correction. â«Some of them are producing no clinical symptoms. â«25% cases of CRF are due to congenital anomalies â«8 to 10 % of children affected with congenital anomalies of urinary tract.
- 5. en Kidney and Ureter Bladder and Urethra âąRenal agenesis âąRenal hypoplasia âąHorse-shoe kidney âąPoly cystic renal disease âąEctopic kidney âąDuplication of renal pelvis and ureter âąHydronephrosis âąPelvi-ureteric obstruction âąCongenital renal neoplasm âąureterocele âąEctopia vesicaehus âąPatent urachus âąBladder and neck obstruction âąPosterior urethral valves âąNeurogenic bladder âąHypospadias âąEpispadias âąPhimosis âąUrethral stenosis âąMeatal stenosis
- 6. Renal agenesis Definition :It is the absence of kidney due to failure of ureteric bud formation. Type: Bilateral Unilateral
- 7. Renal hypoplasia and dysplasia â«it occurs due to reduction of renal mass affecting the nephron. â«It may be unilateral or bilateral â«It may be segmental, simple RENAL DYSPLASIA : â«Disorganization of lung parenchyma with immature nephron and ductal elements resulting in large or small kidney. â«It may be multicystic , hypo plastic or aplastic
- 8. Horse â shoe kidney â«It develops when lower poles of the kidneys are fused in the midline due to fusion of ureteric buds during fetal development. â«Child presents with pyuria, albuminuria, vomiting â«Surgery is indicated
- 9. Polycystic kidneys â«Commonest congenital anomalies as inherited autosomal disease. â«It is an complex syndrome â«Resulting from progressive dilatation of specific portion of the nephron. Types : infantile adult Diagnosis : IVP , renal angiography
- 10. Obstructive lesions of the urinary tract â«It mainly caused by congenital abnormalities like pelvi-ureteric junction obstruction and posterior urethral valves which may lead to irreversible renal damage.
- 11. Pelviâ uretericjunctionstenosis â«Unilateral or bilateral â«Urinary tract infections and upper abdominal pain Diagnosis : ultrasound, IVP , renal function test Management: â«Surgery is indicated for removal of obstruction
- 12. hydronephrosis â« It is the dilatation of renal pelvis â« Unilateral or bilateral â« Due to obstruction of urine flow in the distal urinary tract â« Males > females â« Abdominal pain, failure to thrive , anemia, hypertension, hematuria, renal failure. Diagnosis : USG, IVP ,MCU micturating cysto- urethrogram ( Management : â« Surgical removal or pyeloplasty,percutaneous nephrostomy
- 14. Posteriorurethralvalve â«Distant urinary tract obstruction â«Dribbling of urine, abnormal urine stream, palpable bladder, recurrent urinary tract infections, vomiting and failure to thrive Diagnosis : MCU, USG and endoscopy Management : urinary catheterization, baloon catheter or endoscopic fulgration, cutaneous vesicostomy, pyelostomy
- 15. Meatal stenosis â« Congenital abnormality â« Due to meatal ulcer and scaring â«Meatal dilatation or meatoplasty
- 16. Exstrophyof bladder(ectopiavesicae) â«It is a congenital malformation â«Lower portion of the abdominal wall and the anterior wall of the bladder are missing so that bladder is everted through the opening and may found on the lower abdomen with continuous passage of urine to the outside. â«Male are more commonly affected
- 17. Clinical manifestations: â« Urinary dribbling â« Skin excoriation â« Infection and ulceration or the bladder mucosa â« Ambiguous genitalia â« UTI â« Growth failure Diagnosis : â« Cystoscopic examination â« X-ray â« USG â« IVP
- 18. Management : â«Surgical closure of the bladder within 48 hours â«Urinary conversion before reconstructive surgery â«Orthopedic surgery â«Supportive nursing care â«Pre operative care â«Post operative care â«Follow up
- 19. epispadias â«Abnormal urethral opening on the dorsal aspect of penis. â«Due to abnormal development of the infraumbilical wall and upper wall of urethra. â«Rare in females Classification : anterior epispadias posterior epispadias female epispadias â bifid clitoris subsymphyseal with incontinence of urine
- 21. Management : surgical correction 1. 1.5 to 2 years of age for penile lengthening, elongation of urethral strip and chordee correction. 2. operation done at least 6 months after first stage for urethral reconstruction 3. 3 to 4 years of age for bladder neck reconstruction and correction of VUR Vesicoureteral reflux â« Cystoplasty â« Supportive nursing care
- 22. hypospadias â« it is the congenital abnormal urethral opening on the ventral aspect( under surface ) of the penis. â«Common in male children. Classification : â«Anterior hypospadias(65 to 70%) : it may found as glandular or coronal or on distal penile shaft â«Middle (10-15%) penile shaft hypospadias. â«Posterior hypospadias(20%) : it may be found on proximal penile shaft or as penoscrotal,scortal or perineal type.
- 23. Problems related to hypospadias : 1. Painful downward curvature of penis 2. Deflected stream of urine 3.Inability void urine while standing Management : â« surgical reconstruction â« Meatotomy â« Chordee correction â« urethroplasty
- 24. phimosis â«Narrow opening of the prepuce that prevents it being drawn back over the glans penis. Management: â«Circumcision â« apply Betamethasone cream
- 25. paraphimosis â«It is the retraction of a phimotic foreskin, behind coronal sulcus. â«It may develop phimotic child which also need for surgical management by circumcision or reduction with application of lubricant under deep sedation. Clinical features : â«edematous â«Severe pain
- 26. Wilmâstumor(nephroblastoma) â« Max wilmâs , German surgeon described this most common renal tumor of childhood. â« Chromosomal deletions 11 and 16 â« Highly malignant embryonal tumor â« Tumor develops in kidney parenchyma ,invading the surrounding tissues. Clinical features : â« abdominal mass â« Microscopic hematuria â« Fever â« Pallor â« Superficial vein engorgement
- 27. Clinical staging : Stage 1 - limited to kidney and can be fully excised Stage 2 - Regional extension of tumor by penetration through renal capsule. Stage 3 â non hematogenous extension of the tumor confined to the abdomen following surgery. Stage 4 â hematogenous metastasis to distant organs Stage 5 â bilateral renal involvement
- 28. Diagnostic evaluation : â«History â«Physical examination â«X-ray abdomen ,chest â«USG â«CT scan â«MRI â«Renal function test Management : â«Nephrectomy â«Chemotherapy â«radiotherapy
- 29. Undescended testis â«Testis cannot be made to reach the bottom of the scrotum â«It is also known as Cryptochordism â«5% of full term male infants may have unilateral or bilateral testis. Types : â«Retractile â«Palpable â«impalpable
- 30. Diagnosis : â«USG â«Laproscopy â«MRI Complications : â«Trauma â«Malignant â«Psychological trauma Management : â«Orcheopexy â«Hormonal treatment
- 31. Vesicoâ urethral reflux â« Retrograde flow of bladder urine up the ureter during voiding. Causes: â« Insertion of ureter in to the bladder â« Infection â«Edema Clinical features: â« Dysuria â« Urinary frequency and urgency â« Urine retention â« Cloudy or blood tinged urine
- 32. Management : â«Correction of structural anomalies â«Administration of low dose antibiotics Detectingkidney and urinary tract abnormalities beforebirth â«Ultrasound examination â«Antenatal screening â«Screening of high risk groups
- 33. Prevention of congenital genitourinary anomalies â«Advice to future parents â«To minimize exposure of pregnant women to risk factors â«To prevent over weight/ obesity â«To promote effective information on diet â«To improve folate status â«To avoid contraindicated vaccination â«To include school education programmes
- 34. Nursing management of thechild withurologic surgery â«Promoting understanding of parents â«Preparing for diagnostic procedures â«Involving the parents in child care â«Monitoring intake and output â«Preventing infections â«Providing comfort â«Providing adequate nutrition â«Teaching the parents about related care