URINARY SYSTEM

• Kidney Agenesis or Atresia


  Congenital absence of a kidney
• Kidney Hypoplasia


  Diminished growth of a kidney, can be congenital or result of chronic infection
• Renal Abscess


  Bacterial infection causing a fluid filled sac on the kidney
• Renal Cysts


  Fluid filled, non vascular sacs that can form on the outside of the kidney
• Polycystic Kidney Disease (PKD)


  • Hereditary disease characterized by multiple cysts within the kidneys
  • Cysts expand and put pressure on the nephrons causing obstruction and decreased urine production
  • Can also affect the liver and pancreas
  • Diagnosed with IVP, CT, and ultrasound
  • Treatment in advanced stages includes dialysis and kidney transplants
• Horseshoe Kidneys


  Congenital disease where the lower poles of both kidneys fuse causing the collecting systems to sit at an angle
• Duplication of Collecting Systems

  Most common congenital anomaly of the urinary system, where two ureters emerge from a single kidney
• Horseshoe kidneys


  Congenital disease where the lower poles of both kidneys fuse causing both collecting systems to sit at an angle
• Odd angle of horseshoe kidneys

  Propensity to produce stagnant urine that can eventually become infected
• If no infection is present, horseshoe kidneys will produce no discernable signs and symptoms
• There is no cure for horseshoe kidneys other than treating the symptoms
• Horseshoe kidneys


  • Lower poles of the kidneys are rotated at an angle
• Horseshoe kidneys


  • Close proximity between the horseshoe kidney, the abdominal aorta and the inferior vena cava
• Duplication of collecting systems

  Most common congenital anomaly of the urinary system
• Duplication of collecting systems

  • Two ureters and one renal pelvis are present
  • The ureters may join or enter the bladder separately
  • Can be either unilateral or bilateral
  • Usually does not require treatment
• Ectopic kidney is a congenital defect where the kidney is located in an abnormal position within the body
• Ectopic kidneys


  • Can be located within the boundary of the pelvis or even within the thorax
  • In most cases, will have no affect on urine production
  • May cause infections and kidney stones in some individuals
  • Common course of action is to just treat the symptoms
• Renal calculi


  Presence of a kidney stone is the most common indication for an IVP
• Areas where kidney stones may become lodged

  • The connection of the proximal ureter to the kidney (ureteropelvic junction)
  • Within the ureter
  • The connection between the ureter and the bladder (ureterovesical junction)
  • Within the bladder
  • Within the urethra
• Kidney stones


  • Up to 80% are made of calcium (radiopaque) and the rest are from uric acid (radiolucent)
  • Common symptoms are flank pain, hydronephrosis, pyonephrosis, hematuria
  • Treatments include pain medications, increasing fluids, lithotripsy, surgery
• Kidney stone locations


  • Right UPJ calculus
  • Right UVJ calculus
• Staghorn calculus


  Formation of a large calculus that branches out within the collecting system of the kidney
• Vesicoureteral reflux (VUR)


  Abnormal flow of urine from the bladder back into the ureter
• Vesicoureteral reflux (VUR)


  • Can be caused by hereditary condition, bladder infection, or bladder dysfunction
  • Symptoms include cystitis, nephritis, polyuria, dysuria, pyuria, hematuria, hydroureter/hydronephrosis
  • Commonly diagnosed by voiding cystourethrogram (VCUG)
  • Underlying cause of urinary tract infection in about one third of children
  • Usually corrected with antibiotic therapy, surgery may be indicated in severe cases
• Renal cell carcinoma


  Most malignant neoplasm of the kidneys
• Renal cell carcinoma


  • Has vascular perfusion originating at the renal tubules
  • Propensity to metastasize to lungs, brain, liver, bone
  • Common symptoms include flank pain, hematuria, abdominal mass
  • Often does not present until advanced stage, resulting in high mortality rate
  • Treatment usually consists of nephrectomy
• Wilm's tumor


  Also referred to as a nephroblastoma, most common abdominal neoplasm of infancy and early childhood
• Wilm's tumor


  • Average onset of 3 years old
  • Produces a large, palpable abdominal mass
  • Propensity to metastasize to lungs, liver, skeletal system
  • Early detection and treatment results in nearly 90% 5 year survival rate
• Ureteral diverticula


  Outpouching that occurs due to a weakening in the lining of the ureter
• Ureteral diverticula


  • May be the source of future infections or may trap kidney stones
  • Best demonstrated during an RPG
  • Other than antibiotics, no treatment
• Bladder diverticula


  Outpouching that can be hereditary, caused by enlarged prostate, or chronic bladder infection
• Bladder diverticula


  • May be the source of future infections or may trap kidney stones
  • Other than antibiotics, no treatment
• Phleboliths


  Calcified valves within veins surrounding the urinary bladder
• Phleboliths are sometimes mistaken for kidney or bladder stones and have no clinical importance
• Transitional cell carcinoma (TCC)


  Makes up 90% of all urinary bladder cancers
• Transitional cell carcinoma (TCC)

  • Metastatic cancer mostly seen in men over 50
  • Clearly related to industrial chemicals and smoking
  • Primary symptom is painless hematuria
  • Diagnosed by IVP and cystoscopy
  • Treated with surgery, radiation, chemotherapy
• Reproductive system menu


  • Colovaginal fistula
  • Dermoid
  • Ovarian cyst
  • Pessary
• Colovaginal fistula


  Abnormal passageway between the vagina and rectum
• Colovaginal fistula


  • Provides alternate path for feces and flatulence to exit
  • Often leads to recurrent urinary and vaginal infections
  • Can be caused by trauma, vaginal surgery, or colon cancer
• Dermoid


  Type of teratoma (benign cyst) containing developmentally mature skin, hair, teeth, cartilage, thyroid tissue, sebaceous secretions