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The urinary tract
Published in Spencer W. Beasley, John Hutson, Mark Stringer, Sebastian K. King, Warwick J. Teague, Paediatric Surgical Diagnosis, 2018
Spencer W. Beasley, John Hutson, Mark Stringer, Sebastian K. King, Warwick J. Teague
Children presenting with urinary signs or symptoms should have an initial renal ultrasound scan and sometimes a micturating cystourethrogram. These are good screening tests and will detect most significant abnormalities. Should an abnormality be found, further investigation of the anatomy and function of the urinary tract may be required (e.g. nuclear isotopic scan [and occasionally antegrade or retrograde pyelograms]). A number of rare congenital defects may be found on investigation, including retrocaval ureter, crossed renal ectopia or a patent urachus (although urachal remnants are now recognised to be more common since the advent of ultrasonography). Anomalies not directly related to the urinary tract may cause secondary urinary symptoms (e.g. bladder and urethral compression in pelvic tumours).
Kidneys and ureters
Published in Professor Sir Norman Williams, Professor P. Ronan O’Connell, Professor Andrew W. McCaskie, Bailey & Love's Short Practice of Surgery, 2018
Professor Sir Norman Williams, Professor P. Ronan O’Connell, Professor Andrew W. McCaskie
The fetal kidney arises in the pelvis and ascends to attain its normal position. If this process fails to any degree, the kidney ends up being in a lower-than-normal position. During their ascent, the renal pelvis also rotates from facing anteriorly to facing more medially. The most common anomaly is for the renal pelvis to face anteriorly and the more ectopic the kidney, the more severe is the rotational abnormality. In the majority of cases of renal ectopia, both kidneys are fused. In crossed renal ectopia (Figure76.2), both kidneys are fused and are on the same side - one of the ureters, therefore, crosses the midline to enter the bladder on the correct side of the trigone.
Developmental and positional anomalies of the kidney
Published in Brice Antao, S Irish Michael, Anthony Lander, S Rothenberg MD Steven, Succeeding in Paediatric Surgery Examinations, 2017
Cross-fused renal ectopia occurs in 1 in 7000 with a male-to-female ratio of 2 : 1. The left kidney migrates to the right side three times more than the converse. The majority of cross renal ectopias are fused (85%), and the fusion occurs to the lower pole of the native kidney. The majority of cross-fused ectopias are asymptomatic and remain undetected. For those that are found, 60% present with pyelonephritis, 33% as a palpable mass and 7% are identified on screening for other pathology.
Clinical Presentations and Diagnostic Imaging of VACTERL Association
Published in Fetal and Pediatric Pathology, 2023
Gabriele Tonni, Çağla Koçak, Gianpaolo Grisolia, Giuseppe Rizzo, Edward Araujo Júnior, Heron Werner, Rodrigo Ruano, Waldo Sepulveda, Maria Paola Bonasoni, Mario Lituania
Renal anomalies occur in approximately 50-80% of patients with VACTERL association [32,33]. The renal abnormality spectrum ranges from renal agenesis to horseshoe kidney and MCDKD, which may be also associated with limb defects such as oligodactyly of the foot [50] (Figures 11 and 12), and crossed renal ectopia may be seen (Figures 13 and 14). In some studies, the most common renal manifestation seen in patients with VACTERL association is renal agenesis [51,52] (Figures 15 and 16). In a cohort study conducted by Cunningham et al. [53], vesicoureteral reflux (VUR) in addition to a structural defect was the most common renal anomaly, followed by renal agenesis. Stenosis of the urethra with an enlarged bladder, resembling lower urinary tract obstruction, can also be observed [54]. Urinary anomalies represent a series of diseases capable of causing major morbidity, some of which can be life-threatening. These anomalies often go unrecognized or overlooked, affecting the child’s growth and the future chance of transplant success [55]. In the postnatal period, examination with a voiding cystourethrogram may be required in cases with VUR [5]. Renal agenesis can be diagnosed using US and/or MRI. Renal agenesis and renal artery absence, hypertrophy of the contralateral kidney on US, and MRI with the ipsilateral adrenal gland “lying-down” in the pelvis are recognized MRI diagnostic clusters [56].
Long-term outcomes after pyeloplasty for pelvi-ureteric junction obstruction in adults associated with renal congenital anomalies: Age, sex and renal function matched analysis
Published in Arab Journal of Urology, 2021
Mohamed A. Elbaset, Yasser Osman, Mostafa Elgamal, Mohamed A. Sharaf, Osama Ezzat, Ali M. Elmeniar, Abdalla Abdelhamid, Mohamad H. Zahran
Renal ectopia is a rare disorder occurring in 0.01–0.05% of patients. Half of ectopic kidneys are hydronephrotic, with PUJO associated with 37% of ectopic renal units [13]. The specific problems for this anomaly comprise the abnormal pelvic location of the kidneys (in close proximity to major vessels and pelvic viscera), abnormal vasculature supplying the kidneys, and proximity of the normal ureter to the dilated renal pelvis on the affected side [14].