Posterior urethral valves is a congenital condition caused by abnormal membranes in the proximal urethra that obstruct the flow of urine. It most commonly presents in infancy with failure to pass urine and is diagnosed using imaging like ultrasound and voiding cystourethrography. Treatment involves surgical ablation of the valves via cystoscopy to restore urinary flow and halt renal damage. Prognosis depends on factors like age at diagnosis and degree of renal dysfunction, as patients may develop lifelong complications due to the original renal insults.
POSTERIOR URETHRAL VALVES- Pediatric Surgery
• Dear viewers,
• Greetings from “ Surgical Educator”
• Today I have uploaded one more video in Pediatric Surgery/Pediatric Urology- “ Posterior Urethral Valves”
• Posterior Urethral Valves is the congenital cause for Bladder Outlet Obstruction, resulting in abnormal development of the kidneys as well as the bladder.
• In this video, I talked about the learning outcomes, introduction, etiopathogenesis, clinical features, investigations, differential diagnosis, treatment, follow-up and prognosis of “ Posterior Urethral Valves”
• I hope you will enjoy the video for its educational value.
• You can watch all my teaching videos in the following links
• surgicaleducator.blogspot.com youtube.com/c/surgicaleducator
• Thank you for watching the video.
Presentation delivered at a paediatric clinical meeting of the Federal Medical Center, Lokoja. Nigeria
This presentation doesn't serve as a substitute for texts and/or journals.
POSTERIOR URETHRAL VALVES- Pediatric Surgery
• Dear viewers,
• Greetings from “ Surgical Educator”
• Today I have uploaded one more video in Pediatric Surgery/Pediatric Urology- “ Posterior Urethral Valves”
• Posterior Urethral Valves is the congenital cause for Bladder Outlet Obstruction, resulting in abnormal development of the kidneys as well as the bladder.
• In this video, I talked about the learning outcomes, introduction, etiopathogenesis, clinical features, investigations, differential diagnosis, treatment, follow-up and prognosis of “ Posterior Urethral Valves”
• I hope you will enjoy the video for its educational value.
• You can watch all my teaching videos in the following links
• surgicaleducator.blogspot.com youtube.com/c/surgicaleducator
• Thank you for watching the video.
Presentation delivered at a paediatric clinical meeting of the Federal Medical Center, Lokoja. Nigeria
This presentation doesn't serve as a substitute for texts and/or journals.
The presence of haematuria may be the sole symptom of an underlying disease, either benign or malignant. It is one of the most common presentations of patients with urinary tract diseases and of patients referred for urinary imaging. Painless visible haematuria (VH) is the commonest presentation of bladder cancer.
Please find the power point on Renal and bladder stones. I tried present it on understandable way and all the contents are reviewed by experts and from very reliable references. Thank you
The presence of haematuria may be the sole symptom of an underlying disease, either benign or malignant. It is one of the most common presentations of patients with urinary tract diseases and of patients referred for urinary imaging. Painless visible haematuria (VH) is the commonest presentation of bladder cancer.
Please find the power point on Renal and bladder stones. I tried present it on understandable way and all the contents are reviewed by experts and from very reliable references. Thank you
Vesicoureteric reflux , a common condition in children which could be misdiagnosed . Early diagnosis can help prevent renal scarring and other complications
Ureteropelvic junction obstruction by\ Eman Salman
It was used for student presentation in Urology course rotation
I Hope you find what is helpful for your knowledge ♥
Management of injuries to the specific organs in the abdomen. The clincal presentation of each organ injury, the diagnostic investigations to use and how to treat it definitively and in a damage control setting.
Presentation on the management of abdominal injuries including the causes of abdominal injuries; the classification of abdominal injuries; the initial management of patients with abdominal injuries according to the ATLS; trauma laparotomy
This presentation is a general overview of the various drains used in surgery.
It entails the history of drains, rationale of drains, indications of drains, the factors that affect flowrate, classification of drains and the care of drains.
A brief overview of syphilis and an outlook on the frequently requested VDRL test.
An insight into other investigative modalities for the diagnosis of syphilis.
A power point on the various types of flaps and their respective indications. This presentation briefly describes the various flaps and how to care for flaps.
A presentation
a. The anatomy of the skin
b. The types of skin grafts
c. Indications of a skin graft
d. Mechanism of a graft take
e. Causes of graft failure
f. How to perform skin grafting
Anatomy of the stomach
Brief history of gastric surgery
Indications of Gastrectomy
The different types of gastrectomies.
The various reconstructions following a gastrectomy
Post Gastrectomy syndromes
A presentation on the common hand injuries encountered in the Sub-Saharan region of Africa. At the end of the presentation, common infections of the hand as a complication of hand injuries is elucidated.
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Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
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Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
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Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
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New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
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This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
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The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
2. Introduction
It is a congenital condition characterized by the presence of abnormal obstructing urethral
membranes in the proximal urethra .
Commonest cause of bladder outlet obstruction in infants
Abnormal development of the wolffian and müllerian ducts based on an autopsy study
The presentation of posterior urethral valves is often antenatal, and pathognomonic findings on
postnatal imaging confirm the diagnosis
Surgical procedure may be short but the management may be life-long
the embryonic insults to the bladder, kidneys and other organs can be life-long
3. Epidemiology
In the UK 1 out of every 500 pregnancies has an anomaly of the urinary tract.
The incidence of lower urinary tract obstruction (LUTO) in the UK is 2.2 per 10,000 births,
► Incidence of PUV in the UK is 1.4 per 10,000 births.
► In the US incidence ranges from 1 per 8000 to 1 per 25,000 live births.
• In Nigeria
► There were 3–8 reported cases per annum (Uba et al, 2007)
► A hospital in Port Harcourt observed that it accounted for 1 in 2,447 children (Jaja et al, 2012)
► 71% were already in renal failure at presentation (Odetunde et al, 2012)
It affects male babies
4. Hugh Hampton Young
Historical Overview
Valve-like leaflets was recognized in1769 by Morgagni
Post-mortem findings were confirmed by Langenbeck in 1802.
Hugh Hampton Young described the first endoscopic diagnosis
of a urethral obstruction that was termed posterior urethral
valves.
Also described the various types of PUV
Randall carried out the first endoscopic resection of valves in
1920
6. Pathology
“ The prostatic urethra is markedly dilated. The vesical neck raised and bladder orifice relaxed. Deep
pittings penetrate down into either lateral wall of the prostatic urethra and at the extremity the
verumontanum is seen a fine frenulum which extends distally for about 1 cm, and in dividing, forms
what is apparently a definite valve on either side of the urethra, rising from the floor to each side
wall. Randall carried out the first endoscopic resection of valves in 1920”
Randall 1921
7. Pathology
Crescentic duplication of the urethral mucosa forming paper-thin valves arise from
the verumontanum and extend downward and laterally to the side walls of the
urethra at apex of the prostate.
There may be no hinderance to retrograde instrumentation but the valves come
together to obstruct the flow of urine
Prostatic urethra becomes dilated
Bladder hypertrophy with trabeculations, sacculations and diverticula
Hydroureter and hydronephrosis
8. Type 1 PUV
• The mucosal folds extending
anteroinferiorly from the caudal aspect of
the verumontanum often fusing anteriorly
at a lower level like the membranous
urethra.
• 95% of PUV
9. Type 2 PUV
Bicuspid valves as leaflets radiating
from the verumontanum proximally to
the bladder neck
10. Type 3 PUV
• Valves as concentric diaphragms within
the prostatic urethra, either above or
below the verumontanum
• (~5% of PUVs)
11. Pathophysiology
A vicious cycle of obstructive uropathy and renal dysplasia.
Dam of urine in the bladder and upper segments of the urinary tree.
Thickened bladder wall with reduced bladder compliance (remodelling of the bladder)
Vesicoureteric reflux
Hydroureters and Hydronephrosis
Progressive renal calyceal dilatation and renal damage
Impairment of concentration of urine by the renal tubules
Polyuria
Worsening bladder dysfunction - end-stage bladder, or Bladder valve syndrome.
Worsening renal function leading to ESKD.
12. Diagnosis
Clinical Features
Maternal signs of oligohydramnios
Physical stigmata of oligohydramnios
Potter facies
Clubfeet and deformed hands, and
poor abdominal muscle tone.
Failure pass urine after birth
Infant may pass urine with weak stream with intermittency
The bladder is distended and the kidneys may be palpable
An infant affected by PUV may be affected by comorbidities such as
Pulmonary hypoplasia – tachypnoea, poor respiratory effort, cyanosis
Urinomas – neonatal ascites, respiratory distress
13. Diagnosis
Clinical Features (Delayed Presentation)
Recurrent Urinary tract infection (UTI)
Diurnal enuresis in boys older than 5 years
Secondary diurnal enuresis
Voiding pain or dysfunction
Abnormal urinary stream
Poor growth, hypertension, and lethargy
PUVs are sometimes discovered during evaluation of abdominal mass or renal failure
14. Diagnosis
1. Ultrasonography
Some of the cardinal features of a LUTO are
a. thickened, dilated bladder along with
b. bilateral hydroureter and pelvocaliectasis
c. Oligohydramnios
d. Dilated posterior urethra displaying the “keyhole sign”
Increased renal echogenicity in PUV is an indicator of renal damage.
Very difficult to differentiate PUV from other causes of LUTO like urethral atresia or prune-belly syndrome, bilateral
primary obstructing megaureters
15. Diagnosis
2. Voiding Cystourethrography
Definitive radiologic study in confirming the diagnosis of posterior urethral valves.
Visualization of bladder leaflets
The bladder often appears thickened and trabeculated with multiple diverticuli.
Hypertrophied bladder neck
High-grade vesicoureteral reflux may be seen
2. Radionuclide Renal Scan
The radionuclide renal scan offers quantification of differential renal function
Cortical deficits seen on the study may imply renal dysplasia
20. Treatment
The treatment goals are
To restore flow of urine through the urethra and enable normal cyclic filling and
emptying of the bladder, which is superior to urinary diversion and passive urine
drainage.
Halt the deterioration of renal function
Prevent complications of PUV
Improve the quality life
21. Surgical Interventions
1. Cystoscopy with Valve Ablation
The preferred initial surgical option in any neonate diagnosed with posterior urethral valves
There a various sizes 7.5- or 9-Fr infant cystoscope and can be done in the smallest neonates
The cystoscope is assembled with an ablating device which can be a cold knife or an electrocaultery
Example; Collins knife working, Bugbee electrode
The valves are incised at the ventral 5 and 7 o’clock positions with or without an incision at the dorsal 12 o’clock position
Avoid aggressive resection to prevent strictures from developing
23. Cystoscopy with Valve Ablation
1. Cystoscopy with Valve Ablation
A urethral catheter is typically placed for at least 24 hours after the procedure.
Baby is monitored post-op for improvements in renal parameters or respiratory issues
VCUG must be repeated after valve ablation within 1 month to ensure that the valves are no longer visible.
24. Surgical Interventions
2. Vesicostomy
very low-birth-weight infant whose urethra cannot accommodate an endoscope
Continued impaired renal function, high bladder urine volumes, and upper tract deterioration after valve ablation or
urethral catheterization
27. Surgical Interventions
3. Upper Tract Diversion
Cutaneous ureterostomy or Pyelostomy
It was believed direct decompression of the kidneys will produce direct, low-pressure urinary drainage,
allowing optimization of renal function.
It is complex and not better than the lower urinary diversion.
It not just about the diversion but also about the renal dysplasia
4. Circumcision
vesicoureteral reflux, incomplete bladder emptying, and severe upper urinary tract dilation predispose to
Pyelonrphritis
Circumcision reduces that risk of urinary tract infection by 83% to 92%, a reduction to a level of risk similar to
that for unaffected boys (Wiswell et al, 1988; Mukherjee et al, 2009)
28. Antenatal Surgical Interventions
Antenatal interventions are considered when
Oligohydramnios,
Dilated bladder
Severe hydroureteronephrosis without renal cortical cystic lesions
Normal karyotype.
Vesicoamniotic shunting
Foetal cystoscopy with valve ablation
Cutaneous ureterostomy
vesicostomy
29. Prognostic Factors
a. Serum Creatinine at 1 year of life and (1 month post treatment)
Cr < 0.8 mg/dL appears to indicate a minimal risk
Cr > 1.2 mg/dL higher risk of developing end-stage renal failure
b. Age at diagnosis
c. Renal dysplasia
Hyperechogenic kidneys, cystic cortical changes & loss of corticomedullary differentiation
d. Recurrent urinary tract infections
e. Bladder dysfunction.
30. Quality of Life
Patients with posterior urethral valve have a lifetime of repercussion.
Erectile dysfunction
Infertility.
Persistence of lower urinary tract symptoms – urgency, frequency, incontinence.
Increased risk of UTI.
Development of end stage kidney disease.
Associated co-morbidities of renal transplantation.
31. References
1. Uba AF, Chirdan LB, Ihezue CH, Ramyil VL, Dakum NK. Posterior urethral valves in chilhood:
Experience in a centre with scarce facilities. Afr J Urol. 2007;13:124–31.
2. Jaja T, Anochie IC, Eke FU. Posterior urethral valve in childhood in Port Harcourt, Nigeria. Port
Harcourt Med J. 2012;6:10–6.
3. Odetunde OI, Odetunde OA, Ademuyiwa AO, Okafor HU, Ekwochi U, Azubuike JC, et al.
Outcome of late presentation of posterior urethral valves in a resource-limited economy:
Challenges in management. Int J Nephrol 2012. 2012 345298
4. Baja
5. Medscape
Editor's Notes
Obstructive uropathy accounts for most of these cases
The seminal colliculus of the Veromontanum (Lt – mountain ridge) is a landmark on the floor of the prostatic urethra where the ejaculatory duct opens into the urethra.
It also important in classifying several urethral developmental disorders.
Bladder outlet obstruction leads to detrusor hypertrophy, which increases the voiding pressures initially as the bladder strives to complete emptying.
As further remodeling of the bladder occurs, however, the postvoid residual begins to increase as the urine output increases.
Ultimately, the bladder cannot meet the demand of emptying and the detrusor decompensates.
A 5- or 7-Fr feeding tube, or similar caliber urinary catheter should be inserted per urethra in an infant presenting to the neonatal intensive care unit with a presumed diagnosis of LUTO.
Catheter placement into the bladder may be impeded by the hypertrophied and often elevated bladder neck and curling of the catheter within the dilated posterior urethra. In such cases, a coudé-tipped catheter or, alternatively, using a stylet to curl the tip of the feeding tube dorsally will facilitate bladder drainage.
The association between posterior urethral valves, oligohydramnios, and pulmonary hypoplasia is recognized but the etiology of hypoplasia is unclear and likely multifactorial
Urinomas - A urinoma is the result of a breach of the integrity of the pelvis or calices of the kidney or of the ureter.[4] The urine collection in the perirenal fat causes an inflammatory response with lipolysis resulting in its fibrous encapsulation
Daytime accidental wetting is more likely than bed-wetting to develop after a child has had bladder control for at least 6 months to 1 year (secondary diurnal enuresis).
Improved the antenatal diagnosis of PUV and other LUTO
This study should be completed in the early postnatal period after renal and bladder sonography, and as soon as an infant with suspected prenatal findings of valves is hemodynamically stabilized and able to undergo the contrast study
2. cystogram, same patient. Free vesicoureteral reflux and vesical trabeculation with diverticula.
Laboratory evaluation of a newborn with a diagnosis of posterior urethral valves will, as with any newborn, reflect maternal values
and must be interpreted with caution. After 48 hours, the maternal blood mediated through the placenta should clear, and the infant’s baseline laboratory values may be monitored.
In medicine, the removal or destruction of a body part or tissue or its function
With the miniaturization of endoscopes in the age of fiberoptic and now digital technology, cystoscopy can be accomplished in even the smallest neonate and endoscopic valve ablation is the preferred approach at most centers today.
Posterior urethral valves are thin and associated with minimal vascularity, and aggressive resection should be avoided. Use of a hot loop resectoscope for valve ablation, primarily in older children
4..
It is not uncommon that it is left in for a file while the infant is monitored for improvements in renal parameters or respiratory issues, often in an intensive care environment.
It is not uncommon to see immediate signs of diminished bladder pressures, including some improvement in renal dilation and in the volume of vesicoureteral reflux
With miniaturization of endoscopic technology, vesicostomy is reserved primarily for the very low-birth-weight infant whose urethra cannot accommodate an endoscope, as well as a child with continued impaired renal function, high bladder urine volumes, and upper tract deterioration after valve ablation or urethral catheterization
The overall risk of urinary tract infection in children with posterior urethral valves is 50% to 60%—several magnitudes greater than the 1% risk for unaffected boys
It is known that there is bacterial colonization of the foreskin during the first 6 months of life that may be an important risk factor for the development of UTIs
Advances in fiber-optics and endoscopic miniaturization popularized foetal interventions.
Vesicoamniotic shunting - Biard and colleagues (2005) reported a mean 5.83 years of follow-up on 20 pregnancies with a singleton male fetus that underwent
vesicoamniotic shunting for clear evidence of isolated LUTO and good or borderline urinary sampling parameters. This study found an overall 1-year survival of 91%, and health-related qualityof- life parameters were similar to those in the unaffected, healthy child population.
Data has been difficult because of recruitment issues
Despite numerous advances in antenatal diagnosis and intervention, and rapid postnatal evaluation and treatment, the lifetime
prevalence of end-stage renal disease in boys with posterior urethral valves is between 20% and 50%.
Age at diagnosis remains an unclear predictor of future renal outcomes.
The assumption that antenatal diagnosis would lead to more rapid diagnosis of posterior urethral valves and therefore forestall renal injury has not been sustained. Indeed, Heikkilä and associates (2011) found that patients diagnosed in the presonography era (before 1982) had a risk of end-stage renal disease of 16.8%, as compared to 36.6% developing renal failure if diagnosed during the post-sonography era.
Another review found a similar variation with 41% of those presenting before 1 year of age having poor long-term renal outcome compared to 15% of those presenting a fter 1 year of age
Another common assumption, not corroborated, was that the later-presenting children likely had a milder variant of valve disease, allowing them to go undetected for some years before presenting with more vague symptoms of voiding dysfunction. However, some reports found much worse outcomes in children presenting outside of the neonatal period with posterior urethral valves, with delayed presentation associated with a significantly higher risk of azotemia, higher serum creatinine, and worse long-term renal outcomes
Understanding these long-term risk factors and their impact on quality of life is necessary for counseling, preparing, and treating valve patients as they reach adulthood.