Hernia Of The Urinary Bladder Is Called – The urinary tract consists of two kidneys (where urine is made), two ureters (the tubes that carry urine to the bladder), the urinary bladder, and the urethra (the tube that carries urine from the bladder out of the body). . Urine must flow from the kidney through the ureter into the bladder and through the ureter into the amniotic fluid. There are many causes of urinary tract obstruction. Most of these are caused by a narrowing at some point in the urethra. This contraction can slow or stop the flow of urine, which can impair kidney and lung development.
Amniotic fluid (fetal urine) is crucial for fetal lung development. If there is not enough amniotic fluid, the lungs will not grow. As a result, obstruction of the fetal urinary tract can cause pulmonary hypoplasia (smaller lungs) and renal dysplasia (kidney damage). A low level of amniotic fluid or no amniotic fluid at all may indicate an obstruction to the flow of urine at a certain point in the urethra.
Hernia Of The Urinary Bladder Is Called
The outcome is related to the type of obstruction (where it is in the urethra), the severity of the obstruction, and the effects on renal function and amniotic fluid volume. People who have a blockage or abnormality in one kidney and a normal kidney in the other do very well. Individuals with healthy kidneys can lead normal lives. All unilateral lesions, even those with renal degeneration (dysplasia), can be successfully managed after birth. Mild partial obstruction of both kidneys can be successfully managed after delivery without renal cysts or abnormal urinary electrolytes and maintenance of amniotic fluid volume. It is important to monitor them with serial ultrasounds to maintain sufficient amniotic fluid levels for lung development and to avoid signs of kidney failure.
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It is a good time to plan the time, type and place of delivery. Although most babies will need some sort of surgery after birth, this is usually not an emergency. Most children do not require intensive care and can be examined in the nursery or after discharge from hospital. However, highly enlarged kidneys with expanding ureteric obstruction, any degree of oligohydramnios, and the risk of small lungs should be admitted to intensive care in a specialized center.
At the other end of the spectrum is an obstruction in the urinary system that prevents the emptying of urine from both kidneys. If the obstruction prevents urine from entering the surrounding amniotic space and the amniotic fluid drains away (oligohydramnios), the lungs do not develop. Small lungs can hinder survival after birth. The blockage damages the kidneys and causes kidney failure after birth. Many of these children will not survive.
However, most people with urinary tract obstruction fall between these two extremes, and their outcome depends on the severity of the obstruction and its course during pregnancy. For all types of urinary tract obstruction, those who lose their amniotic fluid (oligohydramnios) before 18-24 weeks will not have enough lungs to survive. Those who maintain amniotic fluid levels during pregnancy have enough lungs to survive birth, but may develop kidney failure after birth due to impaired kidney function before birth. In addition to urological procedures to remove the obstruction and sometimes to reconstruct the urinary drainage system, these children may develop kidney failure for months or years, sometimes requiring a kidney transplant. It works well for those with normal amniotic fluid retention and minor kidney damage, and nothing needs to be done after delivery.
Fortunately, the severity of lung and kidney damage can often be determined by ultrasound and sometimes by examination and analysis of a fetal urine sample. In most cases, serial ultrasound monitoring is necessary. This is true for all unilateral lesions with a normal kidney. These can be safely followed by serial ultrasounds to help maintain amniotic fluid levels and plan the birth and postpartum care.
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Changes in the amount of amniotic fluid, further development of the urinary tract, sonographic appearance of the kidneys (increased echogenicity or brightness indicates kidney damage). If the amount of amniotic fluid is preserved, renal echogenicity is not impaired, and the system is not overdeveloped, these ACEs can be followed by normal near-term delivery and postnatal care. Some may need multiple surgeries after birth, but most will do well.
Obstruction of both kidneys, dilatation of the bladder and ureter, and increased echogenicity of the kidney itself are at the severe end of the spectrum, and some will not survive. Very severely affected es with loss of amniotic fluid before the 18th week of pregnancy and highly echogenic, dysplastic or multicystic kidneys are often unsalvageable. When these symptoms occur, the fetal urine will show saltiness, indicating that the kidneys are not working properly.
Those who have obstruction in both kidneys, do not develop increased echogenicity or dysplasia, and retain the ability of the kidneys to excrete salt from the urine may be salvaged by fetal intervention to relieve ureteral obstruction. These should be carefully studied for renal dysplasia or echogenicity, the degree of ureteric dilatation, the anatomy of the obstruction, the outlet from the bladder or above the bladder, and the amount of amniotic fluid. Fetal intervention candidates can accurately assess the degree of renal impairment by collecting fetal urine 2-3 times over 3-5 days to measure fetal urine electrolytes and beta-2-microglobulin. These tests are highly accurate in predicting fetal kidney function, degree of damage, and likelihood of recovery.
In cases where the urinary obstruction affects both kidneys and there is little or no amniotic fluid, a careful and comprehensive examination is necessary, as fetal intervention may be an option.
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Before the intervention of the fetus, it is necessary to determine whether the kidneys have been damaged, which makes normal function impossible. There are two ways to evaluate the kidneys. The first is through an ultrasound examination. A radiologist can determine on ultrasound whether the kidney tissue is normal or not. The presence of cysts or echogenic (bright white) tissue is usually not a favorable sign.
The second method of determining kidney function is to collect a sample of fetal urine and analyze the levels of electrolytes and proteins. This procedure is performed as an amniocentesis. A needle is inserted into the mother’s abdomen and bladder. A fetal urine sample is collected, the fetal bladder is completely emptied, and the urine sample is sent for testing. A normal karyotype (chromosomes) can also be determined in this urine sample. This procedure should be repeated in 24 to 48 hours, and the fetal urine should be sent again for electrolytes and protein. A third urine sample may be required in another 24-48 hours. Since the first sample has been in the bladder for a long time and cannot provide the best information, the fetal urine sample is collected three times to obtain the most accurate assessment of kidney function. The second sample can be urine that sits in the kidney for a long time and drains into the bladder after the first bladder valve. The results of the analysis of the third sample allow the medical team to provide the most accurate diagnosis and treatment recommendations. The only risk factors for fetal impairment are only bilateral (both kidneys) ureteral obstruction and evidence of good kidney function by ultrasound, electrolytes and proteins.
Patients with bilateral obstruction (usually males with posterior urethral valves) who lose amniotic fluid volume and develop signs of renal failure before 24 weeks require intensive management before and after delivery.
In the most severe cases, there is evidence of progressive renal failure. Kidneys show cysts or increased “clarity” (echogenicity), urinary electrolytes are abnormal, and amniotic fluid may decrease or disappear. These may require decompression and relief of obstruction before delivery.
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The goal of fetal intervention is to allow urine to pass through the obstruction. Restoring the normal flow of urine into the amniotic fluid will allow lung growth and kidney development. Fetal intervention for bladder obstruction has improved significantly over the past 25 years. Initial fetal intervention for bladder obstruction involves open fetal surgery (an incision to expose the uterus) and placement of a vesicostomy (an opening into the fetal bladder). This method
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