Urinary system anomalies can involve the kidneys, ureters, bladder, and urethra. Renal agenesis is the absence of one or both kidneys and can be unilateral or bilateral. Bilateral renal agenesis is fatal, while unilateral may cause no issues if the remaining kidney hypertrophies. Kidneys can also be ectopic, malrotated, fused as in horseshoe kidney, or duplicated. The ureters can be duplicated or a ureter may have an ectopic opening. Bladder anomalies include extrophy and fistulas. Urethral anomalies involve valves, stenosis, hypospadias, and epispadias.
it is uploaded to create awareness about congenital abnormality of urinary system. it also help nursing & paramedics educators to teach their students about it.
it is uploaded to create awareness about congenital abnormality of urinary system. it also help nursing & paramedics educators to teach their students about it.
Congenital anomalies of the kidney and urinary tractDhanya Raghu
CAKUT are a group of phenotypically diverse structural malformations characterized by defects in renal and urinary tract development.
Nearly half of children who develop end-stage renal disease (ESRD) have asymmetric, irregularly shaped kidneys, often referred to as bilateral renal scarring and frequently associated with lower urinary tract anomalies, including vesicoureteral reflux (VUR).
Congenitally abnormal kidneys may be large or small, cystic or irregular in outline, and absent or misplaced.
Symptoms and Signs of different Diseases in UrologyAbdullah Mohammad
How would you approach a Urological Patient? This presentation will tell you how to take a history and examination along with symptoms and common signs of different diseases in urology
This presentation comprises of congenital anomalies of kidney and urinary tract made concise and in depth for PG preparation. It contains all important topics of the regarding subject covered in detail.
Congenital anomalies of the kidney and urinary tractDhanya Raghu
CAKUT are a group of phenotypically diverse structural malformations characterized by defects in renal and urinary tract development.
Nearly half of children who develop end-stage renal disease (ESRD) have asymmetric, irregularly shaped kidneys, often referred to as bilateral renal scarring and frequently associated with lower urinary tract anomalies, including vesicoureteral reflux (VUR).
Congenitally abnormal kidneys may be large or small, cystic or irregular in outline, and absent or misplaced.
Symptoms and Signs of different Diseases in UrologyAbdullah Mohammad
How would you approach a Urological Patient? This presentation will tell you how to take a history and examination along with symptoms and common signs of different diseases in urology
This presentation comprises of congenital anomalies of kidney and urinary tract made concise and in depth for PG preparation. It contains all important topics of the regarding subject covered in detail.
Urinary system – common pathological correlationKochi Chia
Presentation on common urinary system pathologies and radiological findings. Just a brief explanation. Further info can be obtained from www.radiopaedia.org and www.radiologyassistant.nl
HYDRONEPHROSIS (HN)
DEFINITION
It is an aseptic dilatation of pelvicalyceal system due to partial or intermittent obstruction to the outflow of urine.
AETIOLOGY
unilateral
bilateral.
Early embryology - أطلس علم الجنين البشري الباكرMarwan Alhalabi
كتاب “ أطلس علم الجنين البشري الباكر “ للأستاذ الدكتور مروان الحلبي النائب العلمي لكلية الطب بجامعة دمشق و أستاذ طب الإخصاب والجنين والوراثة ..والدكتور حمدي نوفل الاختصاصي في طب الجنين والوراثة وعضو الهيئة التدريسية في كلية الطب بجامعة حلب .. والذي يقدم الأسس الضرورية واللازمة لممارسة طب الإخصاب ومعالجة العقم إضافة إلى العاملين في مختبرات أطفال الأنابيب .. والله من وراء القصد .
Handbooks of COVID-19 - الدليل الطبي المتكامل حول مرض فيروس كوروناMarwan Alhalabi
تم بعونه تعالى إصدار هذا الكتيب (Handbooks of COVID-19 - الدليل الطبي المتكامل حول مرض فيروس كورونا) عن آخر وأحدث التطورات حول داء كورونا المستجد COVID-19: الآلية الإمراضية والتشخيص والوقاية والعلاج .. والذي يوثق الخبرة السريرية لكل المراكز العالمية المتطورة في الوقاية والتشخيص والعلاج والتي نشرت في أهم المجلات الطبية المحكمة بهدف التصدي لهذا المرض .. تمت مراجعته وإعداده بإشراف الأستاذ الدكتور مروان الحلبي النائب العلمي لكلية الطب من قبل مجموعة من طلاب كلية الطب البشري في جامعة دمشق ...حيث ينقل هذا الكتاب أحدث التطورات في المعرفة و الخبرة السريرية الناجحة في تدبير هذا المرض ويختصر على الطواقم الطبية في وطننا الحبيب والدول العربية عناءً كان ثمنه الأرواح ليكون سلاحاً في يديّ مقدمي الخدمات الطبية ضد هذا الوباء الوخيم … كقيمة مضافة للمكتبة الطبية العربية
The content of this book extends beyond the curricula of most medicine, health and bioscience teaching programmes in terms of breadth, but we have limited its depth. Many embryology textbooks cover development in detail, but students struggle to get started,and to get to grips with early concepts. Hopefully we have addressed these difficulties with this book.
هذا الكتيب إعرف عدوك عن آخر وأحدث التطورات حول داء كورونا المستجد الآلية الإمراضية والتشخيص والوقاية والعلاج .. والذي يوثق الخبرة السريرية لكل المراكز العالمية المتطورة في الوقاية والتشخيص والعلاج والتي نشرت في أهم المجلات الطبية المحكمة بهدف التصدي لهذا المرض .. تمت مراجعته وإعداده بإشراف الأستاذ الدكتور مروان الحلبي النائب العلمي لكلية الطب من قبل مجموعة من طلاب كلية الطب البشري في جامعة دمشق ...حيث ينقل هذا الكتاب أحدث التطورات في المعرفة و الخبرة السريرية الناجحة في تدبير هذا المرض ويختصر على الطواقم الطبية في وطننا الحبيب والدول العربية عناءً كان ثمنه الأرواح ليكون سلاحاً في يديّ مقدمي الخدمات الطبية ضد هذا الوباء الوخيم … كقيمة مضافة للمكتبة الطبية العربية
دلائل الإرشاد السريعة لـ COVID-19 - COVID-19 Rapid GuidelinesMarwan Alhalabi
دلائل الإرشاد السريعة من NICE لـ COVID-19
بإشراف: أ. د. مروان الحلبي
ترجمة وإعداد:
د. محمد أيهم محسن
د. نورس الحلبي
د. سهى القاسمي
د. محمد ناصر خطاب
د. عهد حمد
د. محمد الجراد
د. عامر قطان
نيسان 2020
كتيب عن داء كورونا المستجد COVID-19 الوقاية والعلاج - Handbook of COVID-19: P...Marwan Alhalabi
المستشفى الأول التابع لكلية الطب في جامعة Zhejiang
تمَّ تجميعه وفقاً للخبرة السريرية
نقله إلى العربية مجموعة من الأطباء وطلاب كلية الطب البشري بجامعة دمشق
بإشراف الأستاذ الدكتور مروان الحلبي
مرض كورونا المستجد: الدليل الإرشادي في الوقاية والتشخيص والعلاج - Guidance fo...Marwan Alhalabi
كلية الطب - جامعة دمشق
بإشراف الأستاذ الدكتور مروان الحلبي
ترجمة وإعداد:
الدكتور حسام النجم
الدكتور لبيب شاويش
الدكتورة آية ابراهيم
الدكتور مناف جاسم
الدكتور مضاء النجم
الدكتور نورس الحلبي
الدكنورة رهام محمد
الدكتورة لوليا خميس
الدكتور محمد حمود
الدكتور أحمد ابراهيم
الدكتورة باسمة شلغين
آذار 2020
Supervised by: Prof Marwan Alhalabi
review the evidence (RCT & meta-analyses) concerning the best practices in contemporary Recurrent Pregnancy Loss and Thrombophilia depending on Eshre guideline 2017 and other EBM sources.
The genetic material of a cell or an organism refers to those materials found in the nucleus, mitochondria and cytoplasm, which play a fundamental role in determining the structure and nature of cell substances, and capable of self-propagating and variation.
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
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
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.
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
MANAGEMENT OF ATRIOVENTRICULAR CONDUCTION BLOCK.pdfJim Jacob Roy
Cardiac conduction defects can occur due to various causes.
Atrioventricular conduction blocks ( AV blocks ) are classified into 3 types.
This document describes the acute management of AV block.
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
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
Title: Sense of Smell
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 primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
Anti ulcer drugs and their Advance pharmacology ||
Anti-ulcer drugs are medications used to prevent and treat ulcers in the stomach and upper part of the small intestine (duodenal ulcers). These ulcers are often caused by an imbalance between stomach acid and the mucosal lining, which protects the stomach lining.
||Scope: Overview of various classes of anti-ulcer drugs, their mechanisms of action, indications, side effects, and clinical considerations.
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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.
1. Urinary System Anomalies
www.marwanalhalabi.com
Marwan Alhalabi
Professor of Reproductive Medicine and Infertility,
Damascus University
Head of Assisted Reproduction Unit, Orient Hospital
President of Middle East Fertility Society
Past President of Syrian Society of Obstetricians and Gynecologists
3. Anomalies of Kidney & Ureter
Anomalies in number:
1. Bilateral renal agenesis.
2. unilateral renal agenesis.
3. Supernumerary kidney.
Anomalies in structure
1. ARPKD
2. ADPKD
Anomalies in size
1. Hypoplasia
2. Dysplasia
Anomalies in rotation
1. Ventral
2. Dorsal
3. Lateral
Anomalies in ascend
1. Renal ectopia
2. Crossed renal ectopia
without or with fusion.
4. • Complete absence of the kidneys and ureters :
• Prenatal:
-Oligohydroamnios
-US
• postnatal
-Potter,s facial appearance
-Pulmonary abnormalities
-Often a single umbilical artery
• May be caused by failure of formation of either ureteric bud or
nephrogenic blastoma
• It is incompatible with life
Bilateral Renal Agenesis
7. • Absence of one kidney and ureter.
• Occurs more frequently than
bilateral renal agenesis.
• Compatible with life if the solitary
kidney is intact.
Unilateral Renal Agenesis
12. • Autosomal dominant.
• More common than the
infantile type.
• Gradual onset.
• Most of cases are
identified between the
age of 30 and 50 years.
Polycystic Kidney disease-adult Type (ADPKD)
13. • Features:
- Renal mass
- Flank pain
- Hematuria
- UTI
- Later renal insufficiency
- Symptomatic treatment
- Later dialysis
Polycystic Kidney disease-adult Type (ADPKD)
14. • Autosomal recessive.
• Very rare.
• Small cysts representing
generalized dilatation of the
collecting tubules.
• The earlier the age, the more
severe the disease and the worse
the prognosis
Polycystic Kidney disease- Infantile Type
(ARPKD).
15. Features.
• Bilateral.
• Flank pain, renal mass, pulmonary hypoplasia, oliguria,
hypertension.
• If evident at birth, the usual clinical course is death within
the first 2 month.
• If later, renal failure and hypertension occur more slowly.
Polycystic Kidney disease- Infantile Type
(ARPKD).
16. 1. Renal hypoplasia
the term hypoplasia restricted to kidneys that have less
than the normal number of calyces and nephrons
2. Renal dysplasia
kidneys that have abnormal nephron structure (immature
or primitive glomeruli, nephron precursors) and number.
Anomalies in Size
17. • Congenitally small kidney.
• Contains a small numbers of normal
nephrons.
• Renal function is normal in
proportion to the mass of the
kidney.
May be:
• Unilateral.
• Bilateral.
Renal Hypoplasia
18. • Contains focal, diffuse or segmentally arranged primitive
structures.
• Specifically primitive ducts.
• A result of abnormal metanephric differentiation.
• All or only part of the kidney may be affected.
• The kidney may be abnormal in size or small.
Renal Dysplasia
19. • Cysts of various type may be present (cystic dysplasia).
• The entire kidney may be dysplastic with predominance of
cysts (multicystic dysplastic kidney).
Renal Dysplasia
20. • Failure of rotation during ascend to
renal fossa.
• Renal pelvis varies in position from
medial to other degree of
malrotation.
-Ventral position.
-Ventromedial position.
-Dorsal position.
-Lateral position.
Anomalies of Rotation
21.
22. Renal ectopia
• The mature kidney fails to reach its normal location in the renal fossa
Positions :
• pelvic, iliac, abdominal, thoracic,
• Contra lateral = crossed
• Renal pelvis is located anteriorly different from renal ptosis
Anomalies of Ascend
24. • Crossed ectopia with and
without fusion.
• Sigmoid or S-shaped kidney.
• Lump or cake kidney.
• Horse-shoe kidney.
Anomalies of Forms and Fusions
45. • Complete duplication:
2 separate pelves,
2 ureter,2 orifices.
• Two ureteric buds grows
from the mesonephric duct
towards the metanephric
mesenchyme.
Ureteral Duplication
46. Ectopic ureter is liable
to / associated with :
• Reflux
• Stenosis
• Incontinence (only in
female).
• Ureterocoele
Complete duplication
Ectopic ureter
52. Abnormality in:
1. Development of
bladder musculature
and.,
2. Development of
musculature of the
anterior abdominal
wall
Bladder extrophy
53. • Complete: accompanied by
wide separation pelvic
bones, epispadius,
rudimentary penis and
scrotum in boys and cleft
clitoris in girls.
• Incomplete: The defects
are only in the abdominal
and bladder wall.
Bladder extrophy
67. • Abnormal site of external
urethral meatus (ventral).
• Associated with chordee in
most of the cases.
Types:
glanular, coronal,
subcoronal, penile, peno-
scrotal, scrotal, perineal.
Hypospadias
75. Renal Agenesis
• Renal Agenesis (absence):
Can be unilateral or
bilateral
• Renal agenesis results
when the ureteric buds do
not develop or the
primordia (stalks of buds)
of the ureters degenerate.
• Failure of the ureteric buds
to penetrate the
metanephrogenic blastema
results in failure of kidney
development
76. Unilateral Renal Agenesis
• Unilateral renal agenesis (absence)
occurs approximately once in every 1000
neonates.
• Males are affected more often than
females and the left kidney is usually the
one that is absent.
• Unilateral renal agenesis often causes no
symptoms and is usually not discovered
during infancy because the other kidney
usually undergoes compensatory
hypertrophy and performs the function
of the missing kidney.
• Unilateral renal agenesis should be
suspected in infants with a single
umbilical artery
77. Bilateral renal agenesis
• Bilateral renal agenesis is associated with oligohydramnios
(small amount of amniotic fluid) because little or no urine is
excreted into the amniotic cavity.
• This condition occurs approximately once in 3000 births, and
is incompatible with postnatal life.
• Infants with bilateral renal agenesis usually die shortly after
birth.
78. Malrotated Kidney
• If a kidney fails to
rotate, the hilum faces
anteriorly; that is, the
fetal kidney retains its
embryonic position
• Abnormal rotation of
the kidneys is often
associated with ectopic
kidneys.
79. Ectopic Kidneys
• One or both kidneys may
be in an abnormal
position.
• Most ectopic kidneys are
located in the pelvis, but
some lie in the inferior
part of the abdomen.
• Pelvic kidneys and other
forms of ectopia result
from failure of the kidneys
to ascend.
80.
81. Horseshoe Kidney
• In 0.2% of the population, the poles of the
kidneys are fused; usually it is the inferior
poles that fuse.
• The large U-shaped kidney usually lies in the
pubic region.
• Normal ascent of the fused kidneys is
prevented because they are held down by
the root of the inferior mesenteric artery.
• A horseshoe kidney usually produces no
symptoms because its collecting system
develops normally and the ureters enter the
bladder.
• Approximately 7% of persons with Turner
syndrome have horseshoe kidneys.
82. Duplications of Urinary Tract
• Duplications of the
abdominal part of the
ureter and the renal
pelvis are common.
• These defects result
from abnormal division
of the ureteric bud.
83. • A supernumerary kidney with its own ureter, which is rare,
probably results from the formation of two ureteric buds.
84. Ectopic Ureter
• An ectopic ureter does not enter the urinary bladder.
• In males, the ureter usually opens into the neck of the bladder or the
prostatic part of the urethra. They may also enter the ductus deferens,
prostatic utricle, or seminal gland.
• In females, the ureter opens into the neck of the bladder, or the urethra,
vagina, or vestibule of vagina.
• Incontinence is the common complaint resulting from an ectopic ureter
because the urine flowing from the orifice does not enter the bladder;
instead it continually dribbles from the urethra in males and the urethra
and/or vagina in females.
85. Cystic Kidney Diseases
• In autosomal recessive polycystic kidney disease both kidneys
contain many small which result in renal insufficiency.
• Death of the infant usually occurs shortly after birth.
• Multicystic dysplastic kidney disease results from
dysmorphology during development of the renal system.
• In this kidney disease, fewer cysts are seen than in autosomal
recessive polycystic kidney disease and they range in size
from a few millimeters to many centimeters in the same
kidney.
• The cystic structures are wide dilations of parts of the
otherwise continuous nephrons, particularly the nephron
loops (of Henle).
86. URACHAL ANOMALIES
• In infants, a remnant of the urachal lumen may persist in the
inferior part of the urachus.
• In approximately 50% of cases, the lumen is continuous with
the cavity of the bladder.
• Remnants of the epithelial lining of the urachus may give rise
to urachal cysts.
• The inferior end of the urachus may dilate to form a urachal
sinus that opens into the bladder. The lumen in the superior
part of the urachus may also remain patent and form a urachal
sinus that opens at the umbilicus.
• Very rarely the entire urachus remains patent and forms a
urachal fistula that allows urine to escape from its umbilical
orifice
87.
88. CONGENITAL MEGACYSTIS
• A pathologically large urinary bladder—megacystis or
megalocystis—may result from a congenital disorder
of the ureteric bud, which may be associated with
dilation of the renal pelvis.
• Many infants die from this disorder or suffer from
renal failure in early childhood.
89. EXSTROPHY OF BLADDER
• A deficiency of the anterior abdominal wall, is caused by incomplete
median closure of the inferior part of the wall.
• The defect involves both the abdominal wall and the anterior wall of the
urinary bladder; it results from failure of mesoderm to migrate between
the ectoderm and endoderm of the abdominal wall.
• As a result, the inferior parts of the rectus muscles are absent and the
external and internal oblique and the transversus abdominus muscles are
deficient.
90. EXSTROPHY OF BLADDER
• This rare birth defect occurs approximately once in every
10,000 to 40,000 births.
• Exstrophy (eversion) of the bladder usually occurs in
males. Exposure and protrusion of the mucosal surface of
the anterior wall of the bladder characterize this defect.
• The trigone of the bladder and the ureteric orifices are
exposed, and urine dribbles from the everted bladder.
• Epispadias (urethra opens on dorsum of penis) and wide
separation of the pubic bones are associated with
complete exstrophy of the bladder.
91. • Ectopy and hypoplasia associated with
facial maldevelopment
• Ectopy , malrotation and renal agenesis
associated with scoliosis and kyphosis
AGENESIS
• Rare less than 400 cases
• Bilateral … 50%... incompatible with life
• Unilateral ….compatible with life
• contralateral kidney hypertrophied
• Oligohydromnios
• Defect: ureteric bud fail to develop or
• fail to reach metanephric tissue
• Diagnosis: …ultrasound….CT sca
…cystoscopy.. Ureteric oriffice not
seenComplications… infection, stone,
HDN
CONGENITAL ANOMALIES OF KIDNEY
92. Renal Ectopia / pelvic kidneys
§ Kidney Doesn't ascend,
formed near pelvic brim
§ Usually asymptomatic
§ Present with pain or mass
which one may tempt to
remove as unexplained
pelvic mass
§ May be source of stone,
infection
§ Liable to trauma
§ TREATMENT: Treat the
complication
92
93. RENAL FUSION
Horse shoe kidney (Most common)• Lower poles fused in mid line in
front of 4th lumber vertebra
– ascent impeded by
inferior mesenteric artery
• Symptoms /signs.
usually asypmtomatic ,
flank Pain, hematuria, fever
• Exam : fixed mass below
umbilicus
• Diagnosis: U/S
IVU . Pelvis on anterior surface
• complications: Liable to disease
• angulated ureters + PUJ obstructionà urinary stasis à stones, infection &
obstruction àCRF.
93
94. • Treatment
• Asymptomatic = no treatment
• Mild sypmtoms = treat accordingly
• PUJ or ureteric obstruction, recurrent infections
• Stones
à surgery (pyelolithotomy + /-reconstruction)
• ISTHEMECTOMY with straightening of ureters
– less commonly done.
94
95. Pacake / Discoid Kidney :
-Bilateral fused pelvic kidneys ,
usually near the aortic
bifurcation
Crossed Renal Ectopia :
-Both kidneys are found in the same
side
-In 85-90 %of cases , the ectopic
kidney will be fused to the other side
-The upper pole of the ectopic kidney
is usually fused to the lower pole of
the other kidney , although fusion
may occur anywhere
96. Adult Polycystic kidneys
• Hereditary – autosomal dominant
• 95% bilateral
• Not manifested before 40
• Kidneys enlarged, studded with cysts
• Unyeilding capsule compresses
renal parenchyma causing atrophy
• Liver,lungs and pancreas may be affected
• CAUSE: defect in development of tubules.
• Cyst contents: Amber color fluid but
may be hemorrhagic
96
98. Polycystic kidneys
• US and CT:
• cysts in kidneys,liver, spleen and pancreas
• Blood & debris – cystic adenocarcinoma
• FNA- cytology – differentiates
• IVU
• Enlarged renal shadow,
• Renal pelvis – compressed & elongated
• Calyces – narrow, stretched over cysts ( spider legs / bell shaped)
COMPLICATIONS:
infection of cyst , pyelonephritis, hematuria
98
99. Polycystic kidneys
• Nephrologist :
• BP control, infection,anemia, disturbances of Ca metabolism, low
protein diet to delay need for DIALYSIS
• Urologist:
• Surgical / laproscopic deroofing of cysts ( Rovsing’s operation)
• Relieves pain & pressure à saving kidneys
• Renal transplant/ pretransplant bilateral native kidneys nephrectomy
99
100. solitary / Simple (acquired) renal cysts
• Common, may be multiple ( not always 1 )
• Incidentally found– no treatment needed
• Rarely symptomatic; pain- stretch, bleed in
cyst, infection,mass abdomen
• pelvic cyst at hilum presses PUJ à obs
• IVU: filling defect.
• US, CT :smooth, homogeneous content
• D/D: hydatid cyst, cystic
adenocarcinoma , renal cortical
abscess, HDN
• Percuteneous FNA Cytology
• Treatment… treat complications, in severe
cases cyst excision.
100
101. Infantile polycystic kidneys
• Rare
• Inheritance- autosomal recessive
• Enlarged kidneys – may obstruct labour, Many stillborn
• Die of renal failure in in early childhood
101
102. Multicystic kidney
• Mostly unilateral
• Non heriditary
• Presents as nonfunctioning irregular mass
• Diagnosis: U/S , IVU
• Exploration & removal is treatment of chioce
• DD: wilm’s, neuroblastoma, congenital hydronephrosis
102
103.
104. Abnormalities of renal pelvis and ureter
• Most common, harmless, asymptomatic
• DUPLICATION OF RENAL PELVIS
• Common, usually unilateral – left
• Upper pelvis – small, drains upper calyx
• Asymptomatic no treatnment
• If one moity severly damaged – partial
nephrectomy
104
105. DUPLICATION OF URETER
Often join before reaching bladder,
suffer obstruction ( esp from
stones) & reflux
May open independently, ureter
from upper moity opens distal and
medial to its fellow.
Upper ureter suffers ureterocele.
Lower ureter suffers VUR
Infection, calculus formation, PUJ
obst and VUR, ectopic opening
105
106.
107. Ectopic uretric opening
• Female – into urethra below sphincter on vagina = incotinence since childhood with
desire and passage of urine normally as well.
• IVU and cystoscopy
• Male.continent as opening is above sphincter
• Opening in trigone apex, post. Urethra, seminal vesical or ejaculatory duct – functionally
abnormal, infection common
• Treatment:
• Frequently ectopic ureter drains hydronephrotic, chronically infected kidney --- best excised
- nephrectomy
• Incontinence can be cured and renal function preserved by implanting ureter into bladder (
tunneling) or joining its fellow. (URETERO-NEOCYSTOSTOMY, URETERO-URETEROSTOMY)
107
108.
109. CONGENITAL MEGA URETER
• Uncommon, bilateral
• FUNCTIONAL obstruction at
lower end à dilatation &
infection
• Ureteric orifices normal,
ureteric cath passes easily
• Reflux not feature till opened
endoscopically
• Treatment: refashioning and
tunneled reimplant
109
110. Aberrant vessels
-As the kidney ascends during
embryologic development , it
derives its blood supply from
the aorta at successively higher
levels with regression of the
lower level vessels
-If the lower level vessels persist ,
aberrant renal arteries will be
present
-Aberrant vessels can compress
the ureter anywhere along its
course , giving rise to
obstruction
-With color Doppler , aberrant
vessels may be seen crossing the
ureter at the level of ureteric
obstruction
111. POST (retro) CAVAL URETER
• Right ureter passes
behind
IVC instead of lying to the
right of it (laterally)
• If causing obstruction, can
be devided and joined in
front of cava – long
oblique anastomosis
111
112. URETEROCELE
• Cystic enlargement of
intramural portion of ureter
• Thought to result from
congenital atresia of ureteric
orifice
• Though present since
childhood, unrecognised till
adulthood
• More common in female,
cause BOO by obstructing /
prolapsing into internal
urinary meatus. May even
prolapse out of urethra
112
113. • Adder head on IVU
• Cyst wall composed of
urothelium only
• confirmed on cystoscopy
• Translucent cyst, enlarging and
collapsing as urine flows
• Treatment avoided unless
symptoms of infection / stone
• Endoscopic diathermy
incision / deroofing
• Postoperative MCUG to see
VUR
• Ureteral reimplant
• Sever hydronephrosis,
pyonephrosisà nephrectomy
113
115. EXSTROPHY OF BLADDER
• 3.3 per 100,000 births.
• Male to female 1.5:1ratio.
• incomplete median closure of the inferior part of the wall.
• the inferior parts of the rectus muscles is absent and the external and
internal oblique and the transversus abdominus muscles are
deficient.
Signs and symptoms
Exposure and protrusion of the mucosal surface of the anterior wall of
the bladder characterize this defect.
• The trigone of the bladder and the ureteric orifices are exposed, and
urine dribbles from the everted bladder.
• Epispadias
• Anus and vagina anteriorly located.
• UTI and HDN common
116. Treatment
• Sacral osteotomy with bladder closure.
• Anti ureteral reflux procedure and bladder
neck reconstruction
• Epispadias correction
117. Bladder Diverticula
-Outpouchings from the bladder wall, whereby mucosa herniates through the bladder
wall
-solitary or multiple in nature and can vary considerably in size
-May be congenital (primary) or acquired (secondary)
-A Hutch diverticulum is a congenital bladder diverticulum, seen at vesicoureteric
junction
Usually asymptomatic but can cause bladder outlet obstruction and UTI
-Treatment: symptomatic
• MCUG showing bladder diverticula
118. Urachal anomalies
-Normally, the urachus closes in the last half of fetal life
-There are 4 types of congenital urachal anomalies :
a) Patent urachus (50 %)
b) Urachal cyst (30 %), forms if the urachus closes at the umbilical and
bladder ends but remains patent in between, the cyst is usually
situated in the lower one third of the urachus
c) Urachal sinus (15 %), forms when the urachus closes at the bladder
end but remains patent at the umbilicus
d) Urachal diverticulum (5 %), forms if the urachus closes at the
umbilical end but remains patent at the bladder
-There is 2:1 predominance in males
Treatment:
-- Excision
-- Radical excision if evidence of adenocarcinoma .