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Pathogenesis Stone formation results from a cascade of events that occur during and after urine formation. When the concentration of culprit salts such as calcium and oxalate overwhelm inhibitory factors (e.g. citrate, potassium, magnesium, Tamm–Horsfall muco...

Pregnancy Renal colic is the leading cause of non-obstetric hospital admission in pregnancy . The physiological changes that take place during preg - nancy include an increase in glomerular filtration rate by 50%; increased excretion of calcium, uric acid and...

RENAL CYSTS Renal cysts can be broadly classified into sporadic, acquired and genetic causes.

Renal cell carcinoma RCC is the most common solid neoplasm of the kidney . It accounts for around 90% of renal tumours and constitutes 2–5% of all cancers in adult men and 1–3% in adult women. There has been a recent steady increase in the incidence of RCC....

Retrocaval ureter This is due to anomalous development of the inferior vena cava (IVC) with persistence of the posterior subcardinal vein. The right ureter passes behind the IVC rather than lying on its right side and may lead to ureteric obstruction, hydro...

Sporadic renal cysts Sporadic renal cysts are usually benign. Cysts with thin, sharply defined walls and clear fluid content are known as simple renal cysts. This category of cysts may be diagnosed with certainty by US. Apart from a few thin septa, any variatio...

Surgical management Indications for surgical intervention /uni25CF Failure of medical management. /uni25CF Impaired renal function. /uni25CF Chronic infection – staghorn calculi, matrix calculi. /uni25CF High-risk occupation or geographical location – pilots,...

TUMOURS OF THE KIDNEYS AND URETERS Upper tract urothelial cancer Primary urothelial neoplasms of the renal pelvis and ureter are rare. They account for less than 10% of all urothelial tumours. They are more common in adult men. Important risk factors are tob...

Tuberculosis of the urinary tract Genitourinary tuberculosis (GUTB) accounts for 15–20% of extrapulmonary cases of TB. It is secondary and caused by haematogenous spread of tubercle bacilli from the thoracic lymph nodes or the lungs. GUTB occurs as a result ...

Types of stones Calcium oxalate stones This is the most common type of stone, constituting 60–85% of all stones. Hypercalciuria, hypercalcaemia, hyperoxaluria, hyperuricosuria and hypocitraturia are known metabolic abnormalities that can predispose to its fo...

URETERS Renal trauma Kidneys are retroperitoneal structures; they are relatively fixed by their vascular pedicles and are well protected by perinephric fat, strong posterior abdominal wall muscles and the lower rib cage. Renal trauma is usually a part of polyt...

Ureteral duplication Duplication of the ureter ( Figure 82.3 ) and renal pelvis is a common anomaly , with an incidence of approximately 1 in 150 births. Unilateral duplication is six times more common than bilateral. It is more common in females. The duplica...

Ureteral trauma Most ureteral injuries are iatrogenic and occur during surgery near the ureter. Gunshot or penetrating injuries to the abdomen can cause ureteric injury . Management of ureteral injuries as a result of external trauma is dictated by the sever...

Ureterocele Ureterocele is a cystic enlargement of the intramural ureter, which probably occurs as a result of atresia of the ureteric orifice. It has a female-to-male ratio of 4:1 and occurs bilat - erally in 10%. Similar to ectopic ureters, ectopic ureteroc...

Wilms’ tumour See also Chapter 17 . This is the most common tumour of childhood, account - ing for 5% of all childhood cancers. They are bilateral in 5% of cases and familial in 1%. The tumour has mixed elements derived from the embryonic nephrogenic tissue,...

APPLIED ANATOMY OF THE BLADDER Arterial supply /uni25CF Superior vesical artery (from the umbilical artery , which arises from the internal iliac artery). /uni25CF Inferior vesical artery (directly from the anterior division of the internal iliac artery , or ...

APPLIED EMBRYOLOGY OF THE BLADDER The bladder originally develops from the cloaca, the endodermis-lined hindgut structure that is the common open ing for the urinary , genital and gastrointestinal tracts. Between weeks 4 and 7 of gestation, the cloaca is part...

APPLIED PHARMACOLOGY OF THE BLADDER The two predominant neurotransmitters controlling LUT function are acetylcholine and noradrenaline (norepinephrine). Acetylcholine from the somatic nervous system causes contrac tion of striated muscle by activating nicotin...