الفهرس 
Prenatal diagnosisOnly 14 pages are availabe for public view
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Abstract
N
eonatal urological emergencies are those conditions involving the newborn genitourinary system that warrant emergent or urgent consultation within the first month of life(David and Rafael, 1998).
Management of neonatal urological emergencies can be divided into those which need immediately surgical intervention and those which need immediately conservative measures or urgent evaluation to avoid any deterioration.
Because congenital adrenal hyperplasia (CAH) may result in salt wasting, which may be life threatening, those with ambiguous genitalia must be evaluated quickly and stabilized. Lifesaving physiologic replacement dosing of glucocorticoid (by endocrinologist) is begun as soon as the diagnosis is confirmed (Merke and Bornstein, 2005).
Adrenal hemorrhage is usually self-limited; surgical exploration should only be performed if the hemorrhage is not controlled or a hematoma develops into an infected abscess and needs to be drained. Blood or volume replacement may be indicated if the infant has signs of hypovolemic shock (Huang et al., 2000).
Indications for emergent treatment in neonates with PUJO include mass effect from giant hydronephrosis, infants with bilaterality (in up to 20%–25%) or obstruction in a functionally solitary kidney may present with oliguria or even renal failure and severe pyelonephritis. Immediate decompression of the obstructed upper tract via PCN in addition to broad-spectrum intravenous antibiotics are nessesary (Jeffrey and Mark, 2006).
If a boy is born with suspected PUV, drainage of the bladder and, if possible, an immediate VCUG is necessary. Catheterization with a 3.5-5 F catheter (feeding tube) or suprapubic catheterization is mandatory (Tekgül et al., 2009).
The reason for aggressive management of VUR is to prevent renal scarring, which may result in end-stage renal disease (Hsieh et al., 2007).
No intervention is generally recommended for MCDK unless the size of the kidney, which can be very large, leads to respiratory compromise or feeding problems due to compression of the gastrointestinal tract (Jeffrey and Mark, 2006).
Treatment for ARPKD patients is supportive, with close renal and hepatic monitoring. Dialysis and renal transplant are end stage treatments available to those who have severe disease resulting in renal failure (Milla et al., 2007).
Gross hematuria may indicate renal venous thrombosis or renal arterial thrombosis. Both may be life threatening (Kuhle et al., 2004).
Unilateral disease of renal vein thrombosis is best treated conservatively, with rehydration and correction of predisposing factors; however, bilateral thrombosis requires more aggressive treatment such as systemic anticoagulation or thrombolysis and is associated with a worse prognosis (Cook and Koury, 2007).
Unilateral renal artery thrombosis is best managed expectantly, although thrombolytic therapy may be appropriate. Control of hypertension is the most important aspect of management and occasionally requires removal of a non functional kidney (Criag, 2007).
The causes of ARF should be precisely defined and prerenal factors corrected. Adequate ventilation and adequate hydration are mandatory. If intrinsic renal failure has become established, management of the metabolic complications should be done mainly by a nephrologist. Management of post renal failure is achieved by correction of the cause of obstruction (Sharon, 2004).
Indications for dialysis(peritoneal or hemodialysis) include severe fluid overload, hyperkalemia, electrolyte abnormalities that cannot be corrected medically, or severe central nervous system (CNS) depression secondary to uremia(Cendron and Elder, 2002).
¬¬¬¬¬¬¬¬¬¬¬¬¬¬¬¬¬¬¬¬¬¬¬¬¬¬¬¬¬¬¬¬¬¬¬¬¬¬¬¬¬¬¬¬¬¬¬¬¬¬¬¬¬¬¬¬¬¬¬¬¬When unexpected delivery of a child who has exstrophy occurs, the child should immediately be transferred to a tertiary center where a pediatric urologist with expertise in the care of these infants is available. The care of the infant before transfer should include suture ligation of the umbilical cord, rather than clamping, to avoid erosion of the exstrophy plate. In addition, a non adherent protective dressing such as non sterile cellophane should be applied rather than gauze, which can denude the mucosa when removed. A renal ultrasound is necessary soon after birth but should not delay transport of the neonate (Jeffrey and Mark, 2006).
Treatment of Paraphimosis involves reduction of the foreskin manually after applying gentle constant pressure to the edematous foreskin with or without local anesthesia or surgically by division of the phimotic ring (Cook and Koury, 2007).
Neonates with acute problems related to circumcision as bleeding or glans amputation are best managed by the immediate evaluation and treatment under subspecialist supervision (Cook and Koury, 2007).
Febrile UTIs are treated emergently because newborns are particularly susceptible to significant renal damage if the infection is not treated promptly (Pitteti and Choi, 2002).
Although Female genital abnormalities usually do not require emergent surgical intervention, they frequently require urgent evaluation by an urologist (Jeffrey and Mark, 2006).
The major initial management of PBS is cardiac and respiratory issues. Early urologic intervention is indicated only for neonates with evidence of bladder outlet obstruction, in which a percutaneous suprapubic tube can be inserted in the neonatal intensive care unit (Anthony and John, 2007).