The presentation provides an overview of medical morbidities following lower spinal surgery in children. The discussion is build upon a postoperative case scenario, however the information could be extrapolated to other lower spinal pathologies.
Acute urinary retention (AUR) is the inability to void despite a full bladder. It can be caused by failure of detrusor contraction or bladder outlet obstruction. Diagnosis involves confirmation of a full bladder on exam and insertion of a urethral catheter. Immediate treatment is catheterization to evacuate the bladder. Further evaluation is then done to identify the underlying cause and provide definitive treatment.
Posterior urethral valves are obstructing membranes in the urethra of baby boys that can cause bladder outlet obstruction. They are the most common cause of bladder outlet obstruction in newborns. Initial management involves bladder drainage, antibiotics, and monitoring for metabolic and electrolyte abnormalities. Definitive treatment is endoscopic ablation of the valves to relieve obstruction, with vesicostomy being an alternative approach. Long-term risks include renal insufficiency, hypertension, and salt-losing nephropathy. Prognosis depends on factors like initial renal function and presence of reflux.
here give the knowledge that you should possess to manage acute and chronic urine retention. the lecture is more concerned about practical patient care and ward setting management. you should minimally be aware about following facts regarding urine retention. the multiple causes of retention will be discussed later in detailed manner. Direction of the lecture seems more toward BPH and acute retention management. beware there are many aspects of a patient present with an AUR. do no harm and always try to keep patient satisfaction. Let me know about your comments an Ideas. try to improve the quality. good luck.
This document provides an overview of common congenital anomalies of the genitourinary system. It discusses abnormalities of the kidneys, ureters, bladder, urethra, and genitals. For each anomaly, it describes the presentation, evaluation, and typical treatment approaches. Common anomalies covered include horseshoe kidney, pelviureteric junction obstruction, vesicoureteric reflux, duplication of the urinary system, ectopic ureter, uretrocele, undescended testis, hypospadias, epispadias, bladder extrophy, and posterior urethral valves.
Posterior urethral valves are congenital anomalies that obstruct the urethra in males. They were first recognized in the 18th century but were not diagnosed endoscopically until the early 20th century. PUVs cause damage to the urinary tract including the bladder, ureters, and kidneys due to increased pressure from blocked urine flow. Treatment involves endoscopic resection of the valves to restore urine flow. Long term follow up is needed due to risks of bladder dysfunction, infections, and renal impairment. Prognosis depends on factors like age of presentation, presence of reflux, and kidney function.
Postpartum voiding dysfunction and urinary retention is common after delivery and can lead to complications if not properly managed. Risk factors include instrumental delivery, epidural analgesia, prolonged labor, and large birth weight. Pathophysiology may involve nerve damage during delivery and physiological changes causing a hypotonic bladder. Management includes encouraging voiding every 2-3 hours during labor, offering an indwelling catheter for 6 hours after an epidural, and measuring voided volumes and post-void residuals to identify retention. Treatment involves catheterization, pelvic floor exercises, analgesia, and clean intermittent self-catheterization if needed.
Urinary incontinence can significantly impact one's quality of life by reducing self-esteem and independence. It becomes more common with age and depends on one's level of incontinence. Overflow incontinence specifically refers to the involuntary loss of urine due to overdistension of the bladder from an underactive or blocked bladder/urethra. Treatment involves surgically correcting any obstructions or using continuous catheter drainage for non-obstructive cases.
Acute urinary retention (AUR) is the inability to void despite a full bladder. It can be caused by failure of detrusor contraction or bladder outlet obstruction. Diagnosis involves confirmation of a full bladder on exam and insertion of a urethral catheter. Immediate treatment is catheterization to evacuate the bladder. Further evaluation is then done to identify the underlying cause and provide definitive treatment.
Posterior urethral valves are obstructing membranes in the urethra of baby boys that can cause bladder outlet obstruction. They are the most common cause of bladder outlet obstruction in newborns. Initial management involves bladder drainage, antibiotics, and monitoring for metabolic and electrolyte abnormalities. Definitive treatment is endoscopic ablation of the valves to relieve obstruction, with vesicostomy being an alternative approach. Long-term risks include renal insufficiency, hypertension, and salt-losing nephropathy. Prognosis depends on factors like initial renal function and presence of reflux.
here give the knowledge that you should possess to manage acute and chronic urine retention. the lecture is more concerned about practical patient care and ward setting management. you should minimally be aware about following facts regarding urine retention. the multiple causes of retention will be discussed later in detailed manner. Direction of the lecture seems more toward BPH and acute retention management. beware there are many aspects of a patient present with an AUR. do no harm and always try to keep patient satisfaction. Let me know about your comments an Ideas. try to improve the quality. good luck.
This document provides an overview of common congenital anomalies of the genitourinary system. It discusses abnormalities of the kidneys, ureters, bladder, urethra, and genitals. For each anomaly, it describes the presentation, evaluation, and typical treatment approaches. Common anomalies covered include horseshoe kidney, pelviureteric junction obstruction, vesicoureteric reflux, duplication of the urinary system, ectopic ureter, uretrocele, undescended testis, hypospadias, epispadias, bladder extrophy, and posterior urethral valves.
Posterior urethral valves are congenital anomalies that obstruct the urethra in males. They were first recognized in the 18th century but were not diagnosed endoscopically until the early 20th century. PUVs cause damage to the urinary tract including the bladder, ureters, and kidneys due to increased pressure from blocked urine flow. Treatment involves endoscopic resection of the valves to restore urine flow. Long term follow up is needed due to risks of bladder dysfunction, infections, and renal impairment. Prognosis depends on factors like age of presentation, presence of reflux, and kidney function.
Postpartum voiding dysfunction and urinary retention is common after delivery and can lead to complications if not properly managed. Risk factors include instrumental delivery, epidural analgesia, prolonged labor, and large birth weight. Pathophysiology may involve nerve damage during delivery and physiological changes causing a hypotonic bladder. Management includes encouraging voiding every 2-3 hours during labor, offering an indwelling catheter for 6 hours after an epidural, and measuring voided volumes and post-void residuals to identify retention. Treatment involves catheterization, pelvic floor exercises, analgesia, and clean intermittent self-catheterization if needed.
Urinary incontinence can significantly impact one's quality of life by reducing self-esteem and independence. It becomes more common with age and depends on one's level of incontinence. Overflow incontinence specifically refers to the involuntary loss of urine due to overdistension of the bladder from an underactive or blocked bladder/urethra. Treatment involves surgically correcting any obstructions or using continuous catheter drainage for non-obstructive cases.
This document discusses urinary incontinence in females. It defines stress incontinence as the involuntary loss of urine during activities that increase abdominal pressure like coughing or sneezing. It notes that stress incontinence and detrusor instability are the most common causes. For stress incontinence, conservative treatments include pelvic floor exercises while surgical options aim to elevate and support the bladder neck. For detrusor instability, behavioral changes and medications are usually first-line management.
Urinary incontinence is the involuntary loss of urine that negatively impacts quality of life. It becomes more common with age and in institutionalized populations. The main types are stress incontinence caused by physical activity, urge incontinence with a strong urge to urinate, and overflow incontinence from an overfull bladder. Causes include weakened pelvic floor muscles from childbirth, aging, and medical conditions. Evaluation involves testing for underlying causes and severity. Treatment options range from lifestyle changes to devices and surgery depending on the type and severity of incontinence.
Vesicoureteral reflux (VUR) is retrograde flow of urine from the bladder to the upper urinary tract. It can be primary due to deficiencies in the ureterovesical junction or secondary due to bladder dysfunction. Diagnosis involves urine tests, ultrasound, VCUG, DMSA scan and urodynamic studies. Most low-grade reflux resolves spontaneously while high-grade reflux is less likely to resolve. Management includes antibiotics and watchful waiting or surgical correction via open or endoscopic techniques like injection of bulking agents. The goal is to prevent urinary tract infections and renal damage.
This case presentation discusses a 52-year-old female tour guide with stress urinary incontinence. Her symptoms worsened over 5 years and she experiences urine leakage after coughing or sneezing. Urodynamics testing revealed stress urinary incontinence. She underwent an anterior repair and tension-free vaginal tape procedure. Treatment options for stress urinary incontinence include lifestyle changes, pelvic floor exercises, medications, and surgical interventions like sling procedures or colposuspension.
Obstetric fistula is an abnormal opening between the vagina and bladder or rectum caused by prolonged obstructed labor without medical care. A study in Ethiopia found 96% of fistulas were caused by labor lasting over 3 days. Women in Ethiopia are at high risk due to cultural practices like early marriage and childbearing, nutritional deficiencies, and limited access to medical care during delivery. Obstetric fistula robs women of their health and social standing, leaving them isolated and living in poverty. International organizations and Ethiopian hospitals are working to prevent fistulas through improved maternal care and treat women who develop this condition.
This document summarizes the issues surrounding female urinary incontinence and the use of mesh. It notes that several governments and regulatory agencies have placed restrictions on transvaginal mesh due to inadequate evidence of long-term safety and efficacy and risk of harm. Studies show mesh can lead to complications like pain, infection, and erosion. Alternatives to mesh discussed include exercises, bulking agents, and new non-surgical therapies like BTL Emsella which uses electromagnetic stimulation of the pelvic floor muscles.
Urinary retention is defined as the inability to completely or partially empty the bladder. It can be caused by obstructions in the urinary tract like kidney stones or enlarged prostate, or by problems with the nerves that control urination. Symptoms include difficulty starting or fully emptying urine, abdominal pressure, and incontinence. Treatment depends on the cause but may involve catheterization to drain the bladder or surgery to remove obstructions. Chronic retention is when incomplete obstruction leads to large residual urine volumes and overflow incontinence.
This document discusses female urinary incontinence. It begins by describing the functions of the urinary system and micturition cycle. It then discusses the different types of urinary incontinence including stress, urge, overflow and mixed incontinence. The document outlines the anatomy involved in maintaining continence like the urethral mechanism and Delancey's level II support. It also discusses various theories of continence. Treatment options covered include conservative treatments like pelvic floor exercises as well as surgical procedures for stress incontinence like vaginal slings and urethrocystopexy.
Urinary incontinence is the involuntary loss of urine that negatively impacts quality of life. It affects women more than men and its prevalence increases with age. There are several types of incontinence with different causes, such as stress incontinence caused by weak pelvic floor muscles, urge incontinence due to an overactive bladder, and overflow incontinence from bladder retention. Diagnosing the type requires considering symptoms, patient history, and urodynamic tests like cystometry and uroflowmetry to evaluate bladder pressures and urine flow. Treatment depends on the underlying cause but can include pelvic floor exercises, medication, or surgery.
Urinary incontinence affects approximately 30% of women and 15% of men, with the most common causes being overactive bladder, weakness of the pelvic floor after childbirth, and bladder outlet obstruction in middle-aged men. Assessment of incontinence considers symptoms and disorders through urine analysis, urodynamic testing like cystometry, and physical examinations. Treatment options include lifestyle changes like fluid management and pelvic floor exercises, as well as drugs like anticholinergics and antimuscarinics.
Urinary incontinence simply means involuntary leaking of urine.
Incontinence can range from leaking just a few drops of urine to complete emptying of the bladder.
Social and hygienic problem.
This document discusses urinary incontinence and provides information on various related topics. It defines urinary incontinence and discusses its epidemiology and various causes. The causes of urinary stress incontinence are explained. Diagnosis and investigations for stress incontinence are outlined, including pelvic exams, postvoid residual measurement, and urodynamic studies. Conservative and surgical management options for stress incontinence are summarized. Overactive bladder is also defined.
Stress urinary incontinence dr. kawita bapatKawita Bapat
This document discusses stress urinary incontinence (SUI), including its definition, prevalence, clinical testing, investigation, and classification systems. It then covers both conservative and surgical treatment options for SUI, with an emphasis on the various surgical procedures. Key points discussed include midurethral sling procedures being the current first-line surgical approach, with transobturator tapes preferred over retropubic or transvaginal needle suspensions. Factors in choosing the appropriate procedure include the presence of other pelvic organ prolapse and the severity of incontinence.
This document summarizes the embryological development of the kidney and various congenital anomalies that can occur. It discusses the three stages of kidney development - pronephros, mesonephros and metanephros. It then describes various anomalies including anomalies of the kidney itself (such as horseshoe kidney), anomalies of the upper urinary tract (including ectopic kidney and renal duplication), and anomalies affecting the lower urinary tract (such as posterior urethral valves, bladder exstrophy, and hypospadias). It provides details on the presentation, diagnosis and management of many of these congenital anomalies of the kidney and urinary tract.
Urinary incontinence general health issue causing trouble to many people due to infrequent urination. here homoeopathy management discussed for incontinence.
Gaurav Nahar discusses undescended testis (cryptorchidism). Cryptorchidism occurs when one or both testes fail to descend into the scrotum. It has a prevalence of 1-4% in full term males and 1-45% in preterm males. Testicular descent is a complex process involving hormonal and mechanical factors. Cryptorchidism can be congenital, acquired, or syndromic. Evaluation involves history, exam to locate any undescended testes, and sometimes imaging or labs. Treatment is usually surgical orchidopexy to position testes in scrotum.
ФГОС ДО п. 4.6 Требования к результатам освоения основной образовательной программы дошкольного образования
Ребёнок обладает развитым воображением, которое реализуется в разных видах деятельности, и прежде всего в игре;
This document discusses urinary incontinence in females. It defines stress incontinence as the involuntary loss of urine during activities that increase abdominal pressure like coughing or sneezing. It notes that stress incontinence and detrusor instability are the most common causes. For stress incontinence, conservative treatments include pelvic floor exercises while surgical options aim to elevate and support the bladder neck. For detrusor instability, behavioral changes and medications are usually first-line management.
Urinary incontinence is the involuntary loss of urine that negatively impacts quality of life. It becomes more common with age and in institutionalized populations. The main types are stress incontinence caused by physical activity, urge incontinence with a strong urge to urinate, and overflow incontinence from an overfull bladder. Causes include weakened pelvic floor muscles from childbirth, aging, and medical conditions. Evaluation involves testing for underlying causes and severity. Treatment options range from lifestyle changes to devices and surgery depending on the type and severity of incontinence.
Vesicoureteral reflux (VUR) is retrograde flow of urine from the bladder to the upper urinary tract. It can be primary due to deficiencies in the ureterovesical junction or secondary due to bladder dysfunction. Diagnosis involves urine tests, ultrasound, VCUG, DMSA scan and urodynamic studies. Most low-grade reflux resolves spontaneously while high-grade reflux is less likely to resolve. Management includes antibiotics and watchful waiting or surgical correction via open or endoscopic techniques like injection of bulking agents. The goal is to prevent urinary tract infections and renal damage.
This case presentation discusses a 52-year-old female tour guide with stress urinary incontinence. Her symptoms worsened over 5 years and she experiences urine leakage after coughing or sneezing. Urodynamics testing revealed stress urinary incontinence. She underwent an anterior repair and tension-free vaginal tape procedure. Treatment options for stress urinary incontinence include lifestyle changes, pelvic floor exercises, medications, and surgical interventions like sling procedures or colposuspension.
Obstetric fistula is an abnormal opening between the vagina and bladder or rectum caused by prolonged obstructed labor without medical care. A study in Ethiopia found 96% of fistulas were caused by labor lasting over 3 days. Women in Ethiopia are at high risk due to cultural practices like early marriage and childbearing, nutritional deficiencies, and limited access to medical care during delivery. Obstetric fistula robs women of their health and social standing, leaving them isolated and living in poverty. International organizations and Ethiopian hospitals are working to prevent fistulas through improved maternal care and treat women who develop this condition.
This document summarizes the issues surrounding female urinary incontinence and the use of mesh. It notes that several governments and regulatory agencies have placed restrictions on transvaginal mesh due to inadequate evidence of long-term safety and efficacy and risk of harm. Studies show mesh can lead to complications like pain, infection, and erosion. Alternatives to mesh discussed include exercises, bulking agents, and new non-surgical therapies like BTL Emsella which uses electromagnetic stimulation of the pelvic floor muscles.
Urinary retention is defined as the inability to completely or partially empty the bladder. It can be caused by obstructions in the urinary tract like kidney stones or enlarged prostate, or by problems with the nerves that control urination. Symptoms include difficulty starting or fully emptying urine, abdominal pressure, and incontinence. Treatment depends on the cause but may involve catheterization to drain the bladder or surgery to remove obstructions. Chronic retention is when incomplete obstruction leads to large residual urine volumes and overflow incontinence.
This document discusses female urinary incontinence. It begins by describing the functions of the urinary system and micturition cycle. It then discusses the different types of urinary incontinence including stress, urge, overflow and mixed incontinence. The document outlines the anatomy involved in maintaining continence like the urethral mechanism and Delancey's level II support. It also discusses various theories of continence. Treatment options covered include conservative treatments like pelvic floor exercises as well as surgical procedures for stress incontinence like vaginal slings and urethrocystopexy.
Urinary incontinence is the involuntary loss of urine that negatively impacts quality of life. It affects women more than men and its prevalence increases with age. There are several types of incontinence with different causes, such as stress incontinence caused by weak pelvic floor muscles, urge incontinence due to an overactive bladder, and overflow incontinence from bladder retention. Diagnosing the type requires considering symptoms, patient history, and urodynamic tests like cystometry and uroflowmetry to evaluate bladder pressures and urine flow. Treatment depends on the underlying cause but can include pelvic floor exercises, medication, or surgery.
Urinary incontinence affects approximately 30% of women and 15% of men, with the most common causes being overactive bladder, weakness of the pelvic floor after childbirth, and bladder outlet obstruction in middle-aged men. Assessment of incontinence considers symptoms and disorders through urine analysis, urodynamic testing like cystometry, and physical examinations. Treatment options include lifestyle changes like fluid management and pelvic floor exercises, as well as drugs like anticholinergics and antimuscarinics.
Urinary incontinence simply means involuntary leaking of urine.
Incontinence can range from leaking just a few drops of urine to complete emptying of the bladder.
Social and hygienic problem.
This document discusses urinary incontinence and provides information on various related topics. It defines urinary incontinence and discusses its epidemiology and various causes. The causes of urinary stress incontinence are explained. Diagnosis and investigations for stress incontinence are outlined, including pelvic exams, postvoid residual measurement, and urodynamic studies. Conservative and surgical management options for stress incontinence are summarized. Overactive bladder is also defined.
Stress urinary incontinence dr. kawita bapatKawita Bapat
This document discusses stress urinary incontinence (SUI), including its definition, prevalence, clinical testing, investigation, and classification systems. It then covers both conservative and surgical treatment options for SUI, with an emphasis on the various surgical procedures. Key points discussed include midurethral sling procedures being the current first-line surgical approach, with transobturator tapes preferred over retropubic or transvaginal needle suspensions. Factors in choosing the appropriate procedure include the presence of other pelvic organ prolapse and the severity of incontinence.
This document summarizes the embryological development of the kidney and various congenital anomalies that can occur. It discusses the three stages of kidney development - pronephros, mesonephros and metanephros. It then describes various anomalies including anomalies of the kidney itself (such as horseshoe kidney), anomalies of the upper urinary tract (including ectopic kidney and renal duplication), and anomalies affecting the lower urinary tract (such as posterior urethral valves, bladder exstrophy, and hypospadias). It provides details on the presentation, diagnosis and management of many of these congenital anomalies of the kidney and urinary tract.
Urinary incontinence general health issue causing trouble to many people due to infrequent urination. here homoeopathy management discussed for incontinence.
Gaurav Nahar discusses undescended testis (cryptorchidism). Cryptorchidism occurs when one or both testes fail to descend into the scrotum. It has a prevalence of 1-4% in full term males and 1-45% in preterm males. Testicular descent is a complex process involving hormonal and mechanical factors. Cryptorchidism can be congenital, acquired, or syndromic. Evaluation involves history, exam to locate any undescended testes, and sometimes imaging or labs. Treatment is usually surgical orchidopexy to position testes in scrotum.
ФГОС ДО п. 4.6 Требования к результатам освоения основной образовательной программы дошкольного образования
Ребёнок обладает развитым воображением, которое реализуется в разных видах деятельности, и прежде всего в игре;
Impact Hub Barcelona: Program of Activities - Fall 2014ImpactHubBarcelona
Impact Hub Barcelona's Program Activities for the Fall 2014 Season: Business Development Programs, Sexy Salads, Hold-ups, Hub Exchanges, Team Finder, Fuck-up Nights (failure stories), TEDx, Tech for Good, Business meets Arts, Sports for Good, Sustainable Fashion, Ethical Finance, Shift Balance, Africa ... The Changemakers have come to Barcelona to stay ;-)
Customers provided positive reviews of their experiences with Confident Group properties and customer support. Several customers noted the spacious and high quality construction of homes. Customers also praised the responsive and helpful customer support team, with some specifically thanking Mr. Ajith and Mr. Siddanth for quickly addressing queries. Overall, reviews indicated customers were satisfied with the quality and commitment shown by Confident Group.
Learn how to make your graduate school dreams possible through #scholarships and financial aid for international students at MIIS!
Apply by the next scholarship deadline at http://go.miis.edu/apply
The meeting minutes discuss a meeting held on September 29, 2014 between KSN Productions and Ranvir Films to discuss their upcoming film project. They reviewed potential actors, ensured all deadlines would be met, and assigned tasks like completing the script, risk assessment, and maintaining their group blog. Action items for their next meeting included finishing work on the blog, printing all documents, and beginning storyboard and location work.
The document outlines materials needed for a Litter Less Campaign craft project at the 14th Primary School of Acharnes, Greece during the 2014-2015 school year. The project involves transforming used egg cartons and cases into a May wreath by decorating them with colors, glitter, ribbons, buttons, beads and other items to look like blossoming flowers. Students will use their imagination to create the wreath and enjoy the project.
El documento presenta los carteles de varios grupos de estudiantes de 3er grado sobre los países hispanos. Cada grupo creó un cartel diferente para exponer sobre aspectos de países hispanos como la cultura, la historia y la geografía. Los carteles fueron realizados por parejas de estudiantes con nombres como Laura y Mesmin, Julia y Salomé, entre otros.
Facebook is a free social media website that allows users to connect with friends by messaging them privately or making public posts visible to all friends. Users can also share photos and videos. People can create public pages for organizations. PowerPoint allows users to create customizable slideshow presentations on any topic and upload them online. YouTube is a website for sharing videos worldwide where anyone can upload and view content for free, and people can subscribe to specific user channels.
Since 2009 ozone solar is concerned solar water heater manufacturer Rajkot, solar panel manufacturer Rajkot, solar LED street light, solar lighting system manufacturer, solar generator manufacturer Rajkot. We are solar swimming pool heater manufacture Rajkot and its installation & services
The document describes the casting choices for roles in a play called "Casting Lullaby". Jacob Brown was chosen to play the main antagonist role because he has a beard and looks older and masculine. Ben Lister, Jack Dickson, and Ben McNamara were all chosen to play police roles because they are strong, masculine characters which suits the roles. Karen Dickson was chosen to play Lucy's mom because as an older woman her characteristics suit the female role. Brett Dickson was chosen to play Lucy's stepdad because his male characteristics make him suited for the short role.
This document discusses key performance indicators (KPIs) and KPI management. It provides information on developing KPIs, including defining objectives, identifying key result areas and tasks, determining work procedures, and creating metrics to measure results. The document also discusses common mistakes in creating KPIs, such as having too many KPIs not linked to key result areas. Additionally, it describes different types of KPIs like process, input, output, leading, lagging, outcome, qualitative and quantitative KPIs.
In the wake of the devastating fire in Mantralaya in Mumbai, we have listed below a few useful pointers, which we recommend you take up with your admin / facilities ream to ensure a safer working environment.
The document discusses the inspirations for a student media production. It draws inspiration from the film Saw in its use of deadly challenges with a time limit. Previous AS level productions informed elements like an anonymous antagonist and similar locations. Successful thriller and horror films generally leave audiences on edge and wondering what will happen next, so the student production aims to end on a cliffhanger to frighten viewers and leave the outcome of the main character's challenge uncertain.
Jerry was a bored goldfish who lived alone in a bowl and followed a strict daily routine. One day, his owners brought home four new fish to keep Jerry company. At first, Jerry was sad that he was being replaced. However, that night he overheard the new fish breaking the rules and having fun. Inspired, Jerry decided to jump bowls and join them, which he successfully did despite their doubts. The next morning, his owner did not notice Jerry had changed bowls. Pleased with his new adventurous life with friends, Jerry had finally come out of his ordinary scales.
The meeting was held on December 5th, 2014 from 2:10-3:10PM in Room A29 of the Media Department at Oaks Park High School. It included Ranvir Jandoo, Sarah Ghile, Keanon Mcsween, and Namrah Siddique to discuss finishing modifications to their planning and research journals and to plan evaluations for their next meeting.
This document discusses diseases of the pancreas. It begins with the development of the pancreas in the embryo, then covers its anatomy, investigations, congenital anomalies, injuries, acute and chronic pancreatitis, pseudocysts, carcinoma, and treatments. For carcinoma, it describes the types, symptoms, investigations, resection of the head of the pancreas, and palliation to relieve jaundice, improve gastric emptying, and provide pain relief and symptom management. Stents are mentioned as a method to relieve jaundice in pancreatic cancer patients.
CONGENITAL RENAL ABNORMALITIES By Dr. Enobong Runcie(0).pptxXavier875943
This document provides an overview of congenital renal abnormalities, including their embryology, classification, and clinical presentation. It describes anomalies of kidney number, structure, and location. It also discusses anomalies of the urinary tract, including duplication of the ureters, posterior urethral valves, and bladder abnormalities. Specific conditions covered in detail include bilateral and unilateral renal agenesis, horseshoe kidney, polycystic kidney disease, prune belly syndrome, and posterior urethral valves. The overview of embryology provides background on the development of the pronephros, mesonephros, and metanephros.
This document provides tips for using a PowerPoint presentation on hydronephrosis:
1. The presentation contains blank slides for active learning where the user or students can provide information before the next slide is shown.
2. It covers topics like the definition, causes, epidemiology, pathology, clinical features, diagnostic studies, differential diagnosis, and treatment of hydronephrosis.
3. By displaying blank slides and having the user or students think about and discuss each topic before showing the next slide, this presentation aims to create an active learning session that can benefit both individual and group study.
- The patient has a history of chronic pancreatitis dating back to 2010 when she was diagnosed with a large pancreatic duct stone. She has undergone multiple procedures to treat this including ERCP, USG, and CT imaging.
- Her current management involves pain relief through lateral pancreaticojejunostomy surgery to help decompress the pancreatic duct and remove the stone causing her chronic pancreatitis. Her post-op recovery was smooth and she was pain free after the procedure.
- Chronic pancreatitis is permanent pancreatic damage caused by inflammation and fibrosis. It has many etiologies including alcohol use, genetics, obstruction, and is characterized by exocrine and endocrine insufficiency. Complications include pseudocysts, pancreatic asc
- The patient has a history of chronic pancreatitis dating back to 2010 when she was diagnosed with a large pancreatic duct stone. She has undergone multiple procedures to treat this including ERCP and pancreaticojejunostomy.
- On current imaging the pancreatic duct remains dilated with a large stone present. The patient presents with ongoing upper abdominal pain.
- Surgical management options discussed include further endoscopic procedures, drainage procedures such as longitudinal pancreaticojejunostomy, or resectional procedures depending on the extent of disease. Pain control and enzyme supplementation are also important aspects of ongoing medical management.
Disorders of micturition can involve problems with bladder filling or emptying. Evaluation includes history, physical exam, urinalysis, ultrasound, and urodynamic study. Treatment depends on the type of voiding disorder but may include scheduled voiding, medications, biofeedback, behavioral interventions, or clean intermittent catheterization. Early intervention can prevent renal damage from high bladder pressures.
The urinary bladder develops from the urogenital sinus in weeks 4-7 of development. The bladder absorbs parts of the mesonephric ducts, forming the trigone. The ureters enter the bladder at the base of the trigone. Prenatally, the bladder appears elliptical and anechoic on ultrasound by 13 weeks. Postnatally, urachal anomalies including patent urachus, umbilical-urachus sinus, urachal cyst, and vesicourachal diverticulum can occur and may require surgical excision.
This document discusses obstructive uropathy in neonates. It presents a case of a preterm baby with bilateral hydronephrosis and a thick bladder wall. Key points discussed include the causes, presentations, investigations, and management of obstructive uropathy. Posterior urethral valves and ureteropelvic junction obstruction are examined in more detail. Vesicoureteric reflux is also summarized. The document emphasizes relieving obstruction, treating infection, and sorting the primary cause in managing obstructive uropathy.
This document discusses obstructive uropathy in neonates. It begins with an example case of a preterm baby with bilateral hydronephrosis and thickened bladder walls. It then provides general information on obstructive uropathy including causes, presentations, investigations, and treatment principles. Specific conditions discussed in more detail include posterior urethral valves, ureteropelvic junction obstruction, and vesicoureteric reflux.
This document discusses benign prostatic hyperplasia (BPH). It begins with the anatomy and development of the prostate gland. BPH is defined as a non-cancerous enlargement of the prostate that narrows the urethra. Risk factors include increasing age and family history. Symptoms include difficulty urinating and frequent urination. Medical management includes alpha blockers and 5-alpha reductase inhibitors to shrink the prostate. Minimally invasive options for BPH include transurethral microwave thermotherapy, transurethral needle ablation, laser therapies, and urethral stents. More invasive options are transurethral resection of the prostate and transurethral incision of the prostate.
A MCU was performed on a 2-year-old child with a history of recurrent UTIs. The study identified vesicoureteric reflux (VUR), where urine flows back from the bladder into the ureters and kidneys. VUR was graded as [grade], indicating [description of grade]. In another case, a MCU was performed on a 2-year-old boy with difficulty urinating. This showed a fusiform dilatation and elongation of the proximal posterior urethra persisting during voiding, as well as a transverse filling defect, indicating the presence of posterior urethral valves. Posterior urethral valves are congenital folds of tissue in the posterior
The document provides tips for using a PowerPoint presentation on rectal prolapse. It recommends:
1. Freely editing and modifying the slides and adding your name.
2. Noting that half the slides are blank except for the title to facilitate active learning sessions.
3. Showing blank slides, asking students what they know, and then showing the content slide.
4. Rerunning the show at the end to reinforce learning.
5. Using this approach for 3 revisions to optimize learning.
It also provides the presentation format and sample content slides on topics like relevant anatomy, aetiology, clinical features, and management of rectal prolapse.
Fetal hydronephrosis is the most commonly detected fetal anomaly on prenatal ultrasound. It can be caused by obstructive or non-obstructive factors. The main obstructive causes are UPJ obstruction, ureterocele, and posterior urethral valves. Evaluation of fetal kidneys includes measuring the APD of the renal pelvis. For intervention, vesicoamniotic shunting can relieve bladder outlet obstruction but carries risks of shunt failure or preterm labor. While shunting may improve renal function in some cases, long term outcomes often still include renal insufficiency or need for transplant.
This document discusses benign prostatic hyperplasia (BPH). It begins by describing the anatomy and development of the prostate. It then explains that BPH involves the non-cancerous enlargement of the prostate gland due to hyperplasia of tissues. Common symptoms include frequent urination, urgency, and weak urine flow. Diagnosis involves digital rectal exam, urine flow rate tests, and ultrasound. Treatment options include medications like alpha blockers and 5-alpha reductase inhibitors or surgical procedures like transurethral resection of the prostate. Complications can include urinary tract infections if left untreated.
This document discusses colorectal malignancies and provides an overview of their embryology, anatomy, clinical features, investigations, staging, and treatment. It begins with the embryological development of the colon and rectum from the primitive gut. It then covers the anatomy of the colon, rectum, and anal canal before discussing the blood supply, lymphatic drainage, and nerve supply. The document outlines the epidemiology and risk factors for colorectal cancer. It also summarizes the pathogenesis, clinical presentation, investigations including endoscopic exams, and guidelines for screening. Lastly, it briefly discusses staging of disease and types of cancer spread.
Posterior urethral valves (PUV) are a congenital obstruction of the male urethra caused by abnormal mucosal folds. A 29 day old infant presented with fever and was found to have PUV. PUV are typically Type I, occurring in over 95% of cases, and cause obstruction of urine flow. Initial management involves bladder drainage and antibiotics. Radiologic studies help characterize the obstruction and assess for complications like hydronephrosis. Transurethral valve ablation is usually curative though long term sequelae can include renal dysfunction or vesicoureteral reflux. Prognosis is better if creatinine normalizes within a month and if a "pop-off"
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Long term medical morbidities following lower spinal surgery in children
1. L O N G - T E R M M E D I C A L M O R B I D I T I E S
F O L L O W I N G L O W E R S P I N A L
S U R G E R Y I N C H I L D R E N
D R . G O P A K U M A R H A R I H A R A N
S E N I O R R E G I S T R A R , P A E D I A T R I C S
N O R T H W E S T R E G I O N A L H O S P I T A L , B U R N I E
T A S M A N I A , A U S T R A L I A
3/5/2016 1
2. HISTORY
• Sacrococcygeal teratoma – antenatal diagnosis at 32 weeks – confirmed with foetal
MRI
• Polyhydramnios and bilateral moderate hydronephrosis
• LSCS – 34 weeks
• Day 3 – enblock removal with coccyx
• Current presentation – UTI
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4. ANTICIPATED PROBLEMS IN
POSTNATAL PERIOD
• Neuropathic bladder
• Neuropathic bowel – constipation
• Impaired growth and development
• Sensory impairment
• Bone and joint problems – DDH and equinus
• Tumour recurrence ( in this case )
• Tethering of spinal cord
• Obesity
• Adolescent and mental health issues
Morbidities common to lower spinal
conditions
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5. MULTIDISCIPLINARY CARE
• Spina bifida clinic – Orthopaedician, urologist, neurologist
• Allied health – Physiotherapy, occupational therapy and orthotics
• Paediatrician – coordination of care
• General practitioner – community support
• Emergency visits – regional hospital
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6. SACROCOCCYGEAL TERATOMA
• Most common neonatal malignancy
• Arise from primitive streak cells located in the coccyx region
• Comprises solid and cystic areas arising from all three embryonic layers
• Most diagnosed antenatally
• Presentation - mass extending off the caudal end
Any lump over the coccyx of a baby
should be assumed to be a
teratoma until proved otherwise
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7. Altman Classification - Type I tumours are primarily external, while type IV lesions are
completely internal
Type IV SCTs - constipation, abdominal pain, or a palpable mass.
May be asymptomatic/ signs of obstruction of the rectum or bladder.
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8. MANAGEMENT OF SACROCOCCYGEAL
TERATOMA
• MRI- to determine extend of intrapelvic tumour
• Could cause obstetric difficulties due to size.
• Surgical resection
• Differential diagnosis- chordoma, ganglioneuroma
3/5/2016 8
9. NEUROGENIC BLADDER
• Presented with continuous leakage of urine - high pressure bladder with renal
dilatation – urodynamic studies – neurogenic bladder
• CIC up to 5 times/ day.
• Anticholinergics to relax the bladder muscles.
• MAG3. Good function
• December 2015: vesicostomy
3/5/2016 9
10. BLADDER FUNCTION
• Evolution of bladder function - involuntary bladder
emptying (urinary incontinence) during infancy to
voluntary control –by five years of age.
• Urinary continence - interrelated network of
autonomic and somatic nerves of the central and
peripheral nervous systems
• Normal coordination – bladder filling and voiding (
based on pressure gradient)
Bladder filling phase - urine storage at low
pressure with high outlet resistance
Voiding phase – sustained detrusor
contraction and low outlet resistance
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11. NEUROGENIC BLADDER
Disruption in the innervation of the bladder or external sphincter.
Congenital anomalies - myelomeningocele
Trauma to the central nervous system (eg, spinal cord injury, post
surgical)
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12. NEUROPATHIC BLADDER
Bladder – neuropathic
Small and noncompliant
Floppy with poor emptying
Sphincter function – determines
Degree of incontinence
Intravesical pressures – backpressure to kidneys
Detrusor- sphincter dysynergia
3/5/2016 12
13. NEUROPATHIC BLADDER
• Flaccid bladder
• High pressure bladder
• Hyperreflexic bladder
• Open bladder neck, and/or overactive
external/internal sphincter
• Lack of coordination between the bladder
and the external sphincter during voiding
and/or bladder filling (detrusor sphincter
dysynergia)
3/5/2016 13
14. CAN WE PREDICT URINARY TRACT
DYSFUNCTION IN SPINAL CORD
PATHOLOGY?
• Spinal lesion location and neurologic examination – doesn’t predict the type or severity
of urinary tract dysfunction,
Bladder controlled below the spinal roots directing lower extremity
function
• "low" level (sacral) myelomeningocele may have unfavourable bladder dynamics even
if lower extremity function is normal
• Evaluation required periodically with ultrasonography and urodynamic studies
3/5/2016 14
15. URODYNAMIC TESTING
• Urethral and rectal catheters - study bladder during filling and voiding in an awake
child.
• Information on detrusor instability, incontinence, compliance, bladder pressure,
bladder capacity, urine flow rate, sphincter activity, and bladder emptying.
• Bladder - filled with contrast during a urodynamic test – allows radiographic
visualization.
• Useful to separate common disorders of overactive bladder (filling phase abnormality)
from those of dysfunctional voiding due to abnormal sphincter or pelvic musculature
contraction during voiding
3/5/2016 15
17. RECOMMENDED TEST FREQUENCY
• Urodynamic study (VCUG,Cystometrogram and electromyogram)
• At birth, 6 months, 1 year, 3 to 4 years and then 2 to 3 yearly thereafter
3/5/2016 17
18. ULTRASONOGRAPHY
• Most commonly imaging modality – bladder dysfunction.
• Anatomical abnormalities - hydronephrosis (obstruction or vesicoureteral reflux, a double collecting
system with an ectopic ureter, or renal scarring)
• Detection and measurement of post-void residual volume( more than 20 mL upon repeat measurement
indicates incomplete bladder emptying )
Incomplete emptying - underactive bladder and dysfunctional voiding
• Measurement of bladder wall thickness – The bladder wall is normally less than 3 mm thick when full or
less than 5 mm thick when relatively empty*.
Thickened bladder wall - outlet obstruction (eg, posterior urethral valves) or functional
abnormality (eg, non-neurogenic dysfunctional voiding)
• Most common cause of a thickened bladder wall is an overactive bladder (92 percent of cases in one
series)**.
3/5/2016 18
19. FOLLOW UP USG
• 3 monthly in first year
• 6 monthly in second year
• Yearly thereafter
• More frequent in
UTI
Noncompliance with CIC
High risk bladder
3/5/2016 19
20. HIGH PRESSURE BLADDER
• Concern - Renal involvement – Renal failure ( focus of management)
• Lifelong problem- requires ongoing management
• Prevention of renal failure
• Oxybutynin
• CIC and cystostomy
• Monitoring for urinary tract infections
• UTI prophylaxis- Trimethoprim/ Cephalexin
• Regular urodynamic study- detrusor muscle function, residual urine and sphincter-
detrusor dyssynergy
3/5/2016 20
21. DETRUSOR- SPHINCTER DYSYNERGIA
• Bladder contracts while the sphincter doesn’t relax – affecting the pathway involving
bladder afferents and the motor innervation of the urethral sphincter
• Symptoms – Daytime and nightime wetting, urinary retention, history of UTIs
• Urodynamic studies
• Self catheterisation
• Cystostomy
• Botulinum toxin injection
3/5/2016 21
22. CLEAN INTERMITTENT
CATHETERISATION
• Recommended early in infancy
Improves outcome
Reduces need for bladder augmentation
Better compliance in late childhood
Could attain independence with CIC by 5 years of age
• Very few complications
Less complications with self catheterisation than assisted
Less complication in boys
3/5/2016 22
23. CLOUDY OR SMELLY URINE
• Increase fluid intake
• Increase frequency of catheterisation to 1 – 2 hourly
3/5/2016 23
24. OXYBUTYNIN
• In overactive bladder
• VUR ( secondary VUR related to high pressure bladder)
Dose
• Less than 12 months – 0.1 mg/kg three times daily ( 1 mg/ml )
• 1 – 5 years – 0.2 mg/ kg/dose TDS
• More than 5 years – Tab Ditropan 5 mg TDS
• Alternative anticholinergic agent – Tolterodine – 1 to 2 mg BD (
3/5/2016 24
25. SURGICAL INTERVENTIONS TO
PROTECT RENAL FUNCTION
• To protect renal function
• Achieve social continence ( not wetting between CIC)
• High bladder pressure causing hydronephrosis despite CIC or in Frequent UTI
Options
• Vesicostomy
• Bladder augmentation
• Mitranoff procedure- conduit between the bladder and abdominal wall – using
appendix – to facilitate independence in catheterisation
3/5/2016 25
26. RECURRENT UTI
• Recurrent urinary tract infections in the past - on Trimethoprim to prevent urinary tract
infections.
• USG kidneys – hydronephrosis returned to normal in 6 weeks( pressure released after
resection)
• DMSA and DTPA/MAG3 scans
3/5/2016 26
27. RECURRENT UTI INSPITE OF CIC
Causes
• Non compliance
• Constipation
• Change in bladder dynamics ( ex spinal cord tethering)
Management
Trial of nocturnal bladder emptying – continuously draining catheter overnight ( reduces
UTI frequency, decreased hydronephrosis, increases bladder capacity, improved urinary
continence)
If unsuccessful – Bladder augmentation cystoplasty.
3/5/2016 27
29. COMPLICATIONS OF CYSTOSTOMY
• UTIs
• Blockage
• Bladder stones
• Bladder cancer
3/5/2016 29
Increased risk of kidney stones
From prolonged immobility – resultant bone
resorption
30. MALIGNANCY
• Bladder cancer ( more common if indwelling for more than 10 years) –urothelial and
adenocarcinoma
• Squamous cell carcinoma
• Watch for skin changes around Cystostomy site
• CT scan
• Biopsy
3/5/2016 30
31. UROLOGIC MANAGEMENT
• Renal function- monitor creatinine
• Renal tract ultrasound- hydro nephrosis, bladder trabeculation, to assess renal structure
• Initially 6-12 weeks, then 6 monthly in toddlers and children
• Urinary tract infection- common- midstream or catheter sample for testing
• Urodynamic studies- to establish filling and emptying pressures of the bladder – to gauge risk to
kidneys.
• Clean intermittent catheterisation- started in the neonatal period
• Medication – Oxybutynin 8 – 12 hourly
• Protective clothing
• Sometimes condom drainage
• Lifelong urologic surveillance
3/5/2016 31
33. DEVELOPMENTAL DYSPLASIA OF HIPS
• Ultrasound hips
• X ray from 6 months
• Pavlik harness
• Surgery
Follow up scans - satisfactory acetabular
growth.
3/5/2016 33
34. EQUINUS DEFORMITY
AFO on both legs for equines deformity.
Had right achillo-tendon lengthening
Muscle strengthening exercises to reduce deformity.
3/5/2016 34
35. TUMOUR SURVEILLANCE
• Periodic AFP measurements - decreasing trend - normal limits now
• Will take time up to 12 to 18 months in some cases
• Decreasing trend more important
3/5/2016 35
36. CO MORBID MEDICAL CONDITIONS
• Scoliosis – X ray
• Pressure sores- feet
• Obesity – increased load on joints
• Adolescent issues- sexuality, disability
• Contraception issues
• Mental health – neuropsychology assessments
• Vocational support
• Transition and transfer to adult services
3/5/2016 36
37. SUMMARY
• Complex medical condition
• Multidisciplinary approach
• Logical evaluation of presenting complaints
• Short term and long management goals
3/5/2016 37