Urogenital Tract Abnormalities

  1. Bladder Exstrophy 

• Presence of an intra-abdominal mass and inability to visualise a bladder
• Low umbilical cord insertion into abdomen
• Amniotic fluid volume and kidneys are normal
• Low umbilical cord insertion into abdomen
• Widening of pubic bones
• Small penis in males.

Clue/Reasons behind bladder exstrophy: 
Failure in urine production caused by: 

1. Bilateral renal agenesis 
2. Bilateral multicystic dysplastic kidneys 
3. Bilateral severe UPJ obstruction 
4. Severe IUGR 

 

2. Bilateral Renal Agenesis

• Severe oligohydramnios
• Absent kidneys
• Lying down adrenal signs 
• Absent renal arteries on colour doppler
• Non-visualisation of bladder over an hour

 

3. Crossed Fused Renal Ectopia 

• Both kidneys on the same side.

 

4. Multicystic Dysplatic Kidney 

• Kidney replaced with multiple cysts of varying sizes 
• Between cysts are dense stroma (usually not normal renal parenchyma) 
• Non-functional 
• Enlarged 
• Distorted reniform contour 
• Renal artery is absent or small 
• Can mimic hydronephrosis 

5. Autosommal Recessive polycystic kidneys

• Increased echogenicity
• Bilateral enlargement of kidneys
• Poor delineation of intrarenal structures
• Numerous tiny cysts are smaller than limit of u/s resolution à but creates multiple acoustic interfaces, accounting for the characteristic of increased renal echogenicity and loss of corticomedullary differentiation

6. Ureteopelvic Junction Obstruction

• Dilated renal pelvis
• Ureter and bladder not dilated
• Thinning of renal cortex
• AFV usually normal

 

7. Vesicoureteral Junction Obstruction

• Two separate non-communicating renal pelves
• Hydronephrosis in upper or lower pole
• Ipsilateral dilated ureter
• Ureterocele

 

8. Ureterocele

• Thin-walled cyst-like structure in bladder
• Overlooked if bladder is empty
• Full bladder can compress ureterocele

9. Lower Urinary Tract (urethral) obstruction

• Dilated UB with dilated proximal urethra (keyhole sign)
• Thickening of UB wall (>2mm) or severely distended UB wall
• Bilateral tortuous hydroureters Hydronephrosis