SU29.2 | Congenital Genitourinary Anomalies — Summary & Reflection

KEY TAKEAWAYS

Congenital genitourinary anomalies are common, often detected as antenatal hydronephrosis, and dangerous chiefly because silent obstruction or reflux can destroy renal function before symptoms appear. Match the presentation to the lesion: PUJ obstruction (renal pelvis) is the commonest cause of antenatal hydronephrosis; posterior urethral valves are a male-only lower-tract obstruction presenting as a neonate with a poor stream, a palpable bladder and bilateral hydronephrosis with oligohydramnios; vesicoureteric reflux presents as recurrent (febrile) UTIs and is graded I–V; hypospadias is a ventral meatus with chordee and a hooded prepuce; and the undescended testis is an empty scrotum. Investigate by question: ultrasound for structure, MCUG (diagnostic for PUV, grades VUR), DMSA for cortical scarring, MAG3 diuretic renogram to confirm true obstruction, plus serum creatinine. Manage by the shared principles — relieve obstruction, preserve renal function, prevent infection, reconstruct — with Anderson-Hynes pyeloplasty for obstructive PUJO, endoscopic valve ablation for PUV, prophylaxis/surveillance vs reimplantation for VUR, urethroplasty for hypospadias (never circumcise), and orchidopexy (~6–12 months) for the undescended testis.

REFLECT

Recall a newborn examination you have performed or observed, or imagine the next one you will do. Did you check the urinary stream in a boy, palpate the abdomen for a distended bladder or a flank mass, inspect the position of the urethral meatus and look for chordee and a hooded foreskin, and confirm that both testes were in the scrotum? Consider how your threshold for action would change if a mother told you her antenatal scans had shown dilated kidneys, or scanty fluid. Now think about the decisions that follow: would you be able to explain to anxious parents why their child needs a MAG3 scan before any operation, or why their son with hypospadias must specifically not be circumcised? Reflect on how understanding the anatomical level of each anomaly turns a confusing list of conditions into a small set of logical, level-based problems with clear investigations and operations.