DISEASES OF URINARY

SYSTEM
CONGENITAL ANOMALIES OF KIDNEY

 1. Unilateral aplasia of hypoplasia

 2. Renal ectopia
 3. Duplication
Unilatera aplasia or hypoplasia

 A. Complete absence of kidney

with absence of ureter
 B. Ureter & pelvis present with
absent kidney(contralateral kidney
is hypertrophied)
 C. Grossly atrophic kidney
Renal ectopia

 A) Pelvic kidney
 B) Horseshoe kidney
 C) Crossed dystopia (unilateral
fusion)
 D) Polycystic kidney
 Pelvic kidney

One kidney fail to ascend

& remain in the pelvic
brim (pelvic kidney)
 Contralateral kidney is in its
normal position.
 Renal artery arises from common
illiac artery.
 Sometimes acute renal diseases
may be misdignosed due to pelvic
kidney & during exploration kidney
may be removed suspecting
unexplained pelvic mass.
 Horse shoe kidney

 Two kidneys are

fused at their lower
poles, giving a shape
like horse shoe
 Commonly occurs in men
 Fusion of upper pole is uncommon
 Lower poles are fused in front of L4
 Angulated ureters behave like pelvi-
urteric junction obstruction leading
to urinary stasis, secondary infection
& nephrolithiasis.
 Crossed dystopia (unilateral
fusion)

 Both kidneys are in one loin & usually

fused
 Ureter of lower kidney crosses midline to
enter bladder on contralateral side
 Unilateral long  Unilateral S-
kidney – both shaped kidney –
renal pelvis lie pelvis of crossed
one above each kidney faces
other laterally
Polycystic kidney

 Hereditary
 More in women than men
 Clinical manifestation usually after
the age of 30
Pathology

 Enormously enlarged kidneys

 Cysts appears like collection of bubbles
below renal capsule
 Cyst may contain clear fluid or thick
brown material or coagulated blood
 18% cases associated with congenital
cystic liver diseases, occasionally
pancreas & lungs may be affected
Clinical features

 Irregular upper quadrant

abdominal mass
 Pain in loin
 Heamaturia
 Hypertension
 Infection
 Ureamia
Signs & symptoms

 Large volumes of urine of low specific gravity

containing traces of albumin.
 Chronic renal failure coz functioning renal
tissues are replaced by cysts
 Anorexia,headache,vague abdominal
discomfort.drowsiness & vomitting due to
biochemical derangement
 Severe anaemia & signs of ESRF
Treatment

 Renal replacement by dialysis

 Renal transplantation
 Rovsing’s operation- rarely done.
deroofing of cysts or uncaping of
cyst to relieve the pressure on
parenchyma
Duplication

 A) Duplex kidney
 B) Duplex renal pelvis
Duplex kidney

 Common, asymptomatic, harmless

condition
 Associated with duplex ureter
 May be associated with
abnormalities of insertion of ureter
into bladder, leading to reflux or
incontinence of urine
Duplex renal pelvis

 Found in 4% patients
 Usually unilateral,more common on
left side
 Associated with duplication of ureters
 Ureters may open independently into
bladder or may be fused in lower
third of their course before entering
into bladder
CONGENITAL ANOMALIES OF
URETER

 A) Duplication of ureter
 B) Congenital Megaureter
 C) Post caval ureter
 D) Ureterocele
Duplication of ureters

 Usually two ureters join before

they reach the bladder, in lower
third of their course & have
common ureteric orifices
 Less commonly, ureters open
independently into bladder
Clinical features

 Infection, calculus formation & PUJ

obstruction are more common
 Failure of normal valvular
mechanism at UVJ leads to reflux &
damage to renal parenchyma
 In case of females, if ectopic ureter opens
into urethra below the sphincter causes
dribbling of micturation or incontinence
 In case of males, no incontinence due to
external urethral sphincter. But if it opens at
the apex of trigone, posterior urethra,
seminal vesicle or in ejaculatory duct, then it
is likely to be functionally abnormal &
infection is more common.
Treatment

 Asymptomatic dupliction needs no

treatment
 In case of reflux causing
hydronephrosis, excision or ectopic
ureter
 In incontinence, implanting ectopic
ureter into bladder or by joining it
to its fellow
Congenital megaureter

 Uncommon
 May be bilateral,associated with
other congenital anomalies
 Functional obstruction at lower end
of ureter leads to progressive
dilatation & tendency to infection
 T/t- refashioning of lower end of
affected ureter
Post caval ureter

 Instead of lying right to inferior

vena cava, right ureter passes
behind inferior vena cava causing
obstructive symptoms
 T/t – division & rejoining in front of
inferior vena cava
 Unusually there may be fibrosis of
retro caval portion of the ureter
 T/t - excision
Ureterocele

 Cystic enlargement of intramural portion of the

ureter, which is supposed to be the result of
congenital atresia of ureteric orifice
 Most common in women
 Remains unrecognized until adult life
 Adder head on excretory urography is
typical
 Occasionally may cause obstruction to
bladder outflow
 Diagnosis by cystoscopy-reveals
translucent cyst emerging from ureter
 T/t –
 Endoscopic diathermy incision for
symptomatic ureterocele
 In advanced cases causing
hydronephrosis or pyonephrosis
nephrectomy is advisable
Congenital anomalies of
bladder

 Ectopia vesicae (exstrophy of bladder)

this is due to complete ventral defect of
urogenital sinus & the overlying skeletal
system, in which anterior wall of bladder &
infraumbilical part of anterior abdominal wall
fail to develop, also overlying muscles & bone
fail to develop.
 There is big spherical defect in
anterior abdominal wall below
umbilicus which is occupied by inner
surface of posterior wall of bladder
 Mucosal edges fuse with skin
 Urine spurts on abdominal wall
 The rami of pubic bones widely
separated
 Epispadis is almost always
associated
Clinical features

 Males more than females(4:1)

 Posterior wall of bladder protrudes
through the defect which is red in
colour
 Everted mucous membrane
becomes ulcerated & painful
frequently & may udergo
metaplastic changes froming
adenocarcinoma
Treatment

 Surgical correction between 4 to 6

yrs of age
 At first diversion of urine into
sigmoid colon
 Followed by excision of bladder &
closure after few mnths
 Although causes recurrent
infection & death of pt. ultimately