Genitourinary

Question 1

Production of urine by the kidney starts at what week gestation?

Answer 1

9

Question 2

How often does the bladder empty and refill during the third trimester

Answer 2

every 25-30 minutes

Question 3

What parts of the urinary tract should be visualized and assessed during an ultrasound?

Answer 3

kidneys, bladder, amniotic fluid

Question 4

At 14 weeks, what produces 2/3 of the amniotic fluid? What produces the other 1/3

Answer 4

2/3 is producted by fetal urination. 1/3 comes from pulmonary fluid

Question 5

What is thought to cause transient dilation of the urinary tract

Answer 5

narrowing of the natural folds within the urinary tract during early development- this will eventually resolve.

Question 6

how does transient dilation typically measure in the second and third trimesters?

Answer 6

pelvis AP less than 6mm in second trimester and less than 8mm in third trimester

Question 7

What are the findings of a Ureteropelvic Junction obstruction (UPJ) and which sex does it more commonly affect?

Answer 7

dilated renal pelvis and calyces. Non-dilated ureters. It more commonly affects male fetuses

Question 8

What measurements mark mild vs moderate dilation for a UPJ?

Answer 8

less than 7mm is mild, 7-15mm is moderate, and greater than 15mm is marked dilation by 32 weeks.

Question 9

Which is more common, UPJ or UVJ

Answer 9

UPJ is more common. It is resposible for 10-30% of renal dilation.

Question 10

What are the findings with a Ureterovesival Junction Obstruction? What causes this obstruction?

Answer 10

dilated ureter and renal pelvis. Non-dilated bladder. Caused by localized dysfunction in lower ureter.

Question 11

In a duplex collecting system, where does the upper pole’s ureter most commonly instert

Answer 11

inferior/medial to normal bladder insertion site

Question 12

What bladder pathology is commonly noted with a duplex collecting system

Answer 12

ureterocele

Question 13

With a duplex collecting system, why might the lower pole appear dilated

Answer 13

reflux of urine.

Question 14

What causes duplicated collecting systems?

Answer 14

additional ureteric bud from the mesonephric duct during development.

Question 15

What might be suspected with a dilated renal pelvis and associated dilated ureter(s). Is there a good prognosis.

Answer 15

Vesicoureteral reflux. Can have a good prognosis if the diagnosis is confirmed early. If not, renal scarring and long-term damage might occur.

Question 16

What is the most common cause of severe bladder outlet obstruction

Answer 16

posterior urethral valve

Question 17

What is a posterior urethral valve

Answer 17

membrane in the urethra that presents with enlarged bladder and urethra (keyhole sign) as well as ureters and renal pelvis in male fetuses.

Question 18

What is the most significant consequence of oligohydramnios?

Answer 18

pulmonary hypoplasia

Question 19

What pathology might be suspected in a male fetus with a massive bladder and oligohydramnios

Answer 19

PUV (posterior urethral valve)

Question 20

What pathology might be suspected in a female fetus with a massive bladder?

Answer 20

urethral atresia.

Question 21

How early can urethral atresia be detected and what is its prognosis?

Answer 21

the megacystis can be detected during the first trimester and often has a poor prognosis.

Question 22

What is congenital megalourethra?

Answer 22

A condition affecting male infants associated with a dilated and elongated urethra and enlarged bladder

Question 23

What causes cloacal malformation

Answer 23

failure of urorectal fold that separates the rectum and genital tract to develop properly.

Question 24

What occurs with cloacal malformation? Who does it affect?

Answer 24

Female fetuses can present with a collection of urine in the uterus/vagina (hydrometrocolpos) as well as bladder obstruction and dilated ureters.

Question 25

What causes prune belly syndrome?

Answer 25

extensive stretching during early development that causes a lax abdominal wall.

Question 26

Who is Prune Belly syndrome more common in? What is its prognosis

Answer 26

It is more common in males and often has a poor prognosis and may lead to pulmonary hypoplasia if oligohydramnios is present.

Question 27

What is megacystis-microcolon-intestinal hypoperistalsis syndrome?

Answer 27

An autosomal recessive condition in females where there is a small bowel obstruction with an enlarged bladder and hydronephrosis.

Question 28

When would a dilated ureter be considered megaureter?

Answer 28

when obstructive processes have been eliminated and the ureter measures over 7mm.

Question 29

Which is more common: unilateral or bilateral renal agenesis. what is its prognosis

Answer 29

unilateral is 3-4x more common, it has a good prognosis, though individuals with this disorder are at risk for renal dysfuction in child/ adulthood.

Question 30

What is aberrant cephalad migration?

Answer 30

An ectopic kidney being located in abother part of the body.

Question 31

Where are horseshoe kidneys most commonly fused?

Answer 31

lower poles.

Question 32

What occurs with crossed fused renal ectopia

Answer 32

fusion of both kidneys with a ureter crossing midline to insert into the appropriate place in the bladder

Question 33

How does AR PKD appear

Answer 33

multiple small cysts involving the collecting system. preserved pelvis and ureters. bilaterally enlarged, hyperechoic kidneys with little differentiation

Question 34

How does AD PKD appear?

Answer 34

few large cysts developing in the areas of the nephron and collecting ducts.

Question 35

Which is more common: ARPKD or ADPKD?

Answer 35

dominant is more common

Question 36

What is medullary cystic dysplasia characterized by?

Answer 36

cystic changes to the medullary tubules

Question 37

What is multicystic dysplastic kidney characterized by?

Answer 37

Unilateral, noncommunicating cysts of varying size, no cortex and irregular.

Question 38

multicystic dysplastic kidney is usually unilateral. What happens when it is not?

Answer 38

When bilateral it is associated with chromosomal disorders and oligohydrmanios which leads to pulmonary hypoplasia and has a poor prognosis.

Question 39

What is the most common renal tumor in a fetus

Answer 39

mesoblastic nephroma

Question 40

What gestational age can non-visualization of the bladder be considered a pathological finding?

Answer 40

beyond 15 weeks.