Abnormalities in the urinary system of infants and children are not uncommon findings in the practice of pediatrics. Ultrasonography now allows diagnosis of various types of lesions in the infant prenatally and in some cases surgical intervention can prevent fetal damage. In most cases, however, management is undertaken postnatally. This continuing education unit presents new techniques in diagnosis and treatment of urinary abnormalities in the fetal and postnatal periods. Topics include: management of the fetus and neonate with hydronephrosis, current views on posterior urethral valves, the undescended testis, and hypospadias.
HOW TO OBTAIN CME CREDITS BY READING THIS ISSUE
Pediatricians can receive Category I credits for the Physician's Recognition Award of the American Medical Association by reading the following articles and successfully completing the quiz at the end of the issue. Complete instructions are given on the quiz pages.
The Pre-Test below has been prepared to assist you in studying the following material. It indicates some of the areas to be covered, and will make it possible for you to challenge your present knowledge of the material before reading further.
1. Intravenous pyelography:
A. Is still the standby study for the newborn with obstructive uropathy.
B. Has too hypertonic a contrast to be safe in the neonate.
C. Delineates anatomy but gives no data regarding function.
D. Has been replaced by ultrasonography as the best first study in suspected obstructive uropathy.
E. Will usually determine the presence of an additional renal vessel associated with UPJ obstruction.
2. Testicular descent usually occurs in:
A. The first trimester of pregnancy
B. The second trimester of pregnancy
C. The third trimester of pregnancy
D. At birth.
E. Anytime during pregnancy
3. The etiologic factors that have been associated with hypospadias include:
B. Maternal age.
C. Paternal testicular anomalies.
D. The administration of progestins.
E. A delay in the maturation of the hypothalamicpituitary-testicular axis.
Which of the above is false?
4. The majority of congenital posterior urethral valves:
A. Are easily diagnosed by a history of a poor urinary stream.
B. Are "one-way" membranous obstructions proximal to the external sphincter area.
C. Extend into the bulbous urethra.
D. Have chronic renal failure.
E. Are now being picked up with prenatal ultrasound.