Congenital anomalies of the ureter, bladder, and urethra

The most common congenital malformations of the ureter, bladder, and urethra include duplicated ureter, retrocaval ureter, ectopic orifice of the ureter, stricture or stenosis of the ureter, ureterocele, exstrophy of the bladder, congenital bladder diverticulum, hypospadias, and epispadias. Some of these abnormalities are obvious at birth; others aren’t apparent and are recognized only after they produce symptoms. (See Congenital urologic anomalies.)

Causes

Congenital anomalies of the ureter, bladder, and urethra are among the most common birth defects, occurring in about 5% of all births. Their causes are unknown; diagnosis and treatment vary.

Special considerations

PEDIATRIC TIP Because these anomalies aren’t always obvious at birth, carefully evaluate the newborn’s urogenital function. Document the amount and color of urine, voiding pattern, strength of stream, and any indications of infection, such as fever and urine odor. Tell parents to watch for these signs at home. In all children, watch for signs of obstruction, such as dribbling, oliguria or anuria, abdominal mass, hypertension, fever, bacteriuria, or pyuria.

❑ Monitor renal function daily; record intake and output accurately.

❑ Follow strict sterile technique in handling cystostomy tubes or indwelling urinary catheters.

❑ Make sure that ureteral, suprapubic, or urethral catheters remain in place and don’t become contaminated. Document the type, color, and amount of drainage.

❑ Apply sterile saline pads to protect the exposed mucosa of the newborn with bladder exstrophy. Don’t use heavy clamps on the umbilical cord, and avoid dressing or diapering the infant. Place the infant in an incubator, and direct a stream of saline mist onto the bladder to keep it moist. Use warm water and mild soap to keep the surrounding skin clean. Rinse well, and keep the area as dry as possible to prevent excoriation.

❑ Provide reassurance and emotional support to the parents. When possible, allow them to participate in their child’s care to promote normal bonding. As appropriate, suggest or arrange for genetic counseling.

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Book Source Details

• Book Title: Professional Guide to Diseases (Eighth Edition)
• Author(s): Springhouse
• Year of Publication: 2005
• Copyright Details: Professional Guide to Diseases (Eighth Edition), Copyright © 2005 Lippincott Williams & Wilkins.

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Copyright Details: Professional Guide to Diseases (Eighth Edition), Copyright © 2008 Williams & Wilkins.

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More About This Book: Title: Professional Guide to Diseases (Eighth Edition) Authors: Springhouse Publisher: Lippincott Williams & Wilkins Copyright: 2005 ISBN: 1-58255-370-X

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