1. CONGENITAL ANOMALIES
LOWER URINARY TRACT
Ahmad Hanno
Professor and Head of Pediatric Urology

2. General
practitionerSurgeon
Urologist
Pediatric Urology

3. I. Urachal anomalies
II. Hypospadias
III. Posterior urethral valves
IV. Exstrophy – epispadias
complex

4. URACHAL ANOMALIES

5. URACHAL ANOMALIES

6. HYPOSPADIAS
 Urethral meatus is ventral in location
 Meatus located proximal to the tip of
glans
 Prepuce is hooded
 Ventral curvature on erection

9. HYPOSPADIAS REPAIR
Straightening of the penis “Orthoplasty”
Extending the urethra to tip of the glans
“Urethroplasty”
Fashioning the new meatus “Meatoplasty”
Refashioning the glans around neo-urethra
“Glanuloplasty”
Covering the neo-urethra with skin

12. POSTERIOR URETHRAL VALVES

13. POSTERIOR URETHRAL VALVES
Remnant obstructing tissues at the distal end
of posterior urethra in males
Prenatal infravesical obstruction
Hydroureteronephrosis, distended bladder
and posterior urethra
Vesicoureteric reflux
Urosepsis
Common cause of renal insufficiency

14. PRESENTATIONS
Prenatal Ultrasound
Postnatal
– Obstructed urinary stream
– Renal insufficiency
– Failure to thrive
– Urosepsis
– Hydronephrosis
– Full bladder

15. DIAGNOSIS US
Key-hole sign
Thick-walled distended bladder

16. DIAGNOSIS VCUG

17. MANAGEMENT
Stabilize the critically ill baby
Urethral “feeding tube”
Transurethral “fulguration” of the valves
Vesicostomy if renal function is impaired
Delayed managenent
– Clean intermittent catheterization
– Attention to reflux
– Bladder augmentation
– Renal Tx

18. TRANSURETHRAL FULGURATION
Endoscopic view

19. TRANSURETHRAL FULGURATION
Fulguration Incision

20. EXSTROPHY – EPISPADIAS COMPLEX
Lack of development of the mesoderm of the
infra-umbilical region
Diastasis of the symphysis pubis
Bladder is opened to the outside
Epispadias in males
Bifid clitoris in the female
Bilateral inguinal hernias are common

22. ABNORMAL BLADDER PLATE IN
THE OLDER CHILD

23. SURGICAL REPAIR
Closure of bladder plate
Complete penile disassembly
Repair of epispadias
Ventral re-location of the urethra
Repair of the clitoris in females
Closure of the abdominal defect
• Simple closure in the first 72 hours
• Bilateral iliac osteotomy thereafter
Attention to continence at age 3 – 5 years