Congenital Anomalies of the Genitourinary Tract as Cause of Obscure Disease

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CONGENITAL anomalies of the genitourinary tract are relatively common and are varied in type. They may be associated with symptoms directly related to the urinary tract and thus come to medical attention. However, they may be responsible for obscure symptoms and should be considered in differential diagnosis.

A detailed discussion of the embryology of the genitourinary tract is not necessary for clinical appreciation of these conditions. However a brief explanation may help to orient our thinking. The genital and urinary organs are closely related in embryologic development. Since both arise from the mesoderm of the intermediate cell mass which is the primordium of the urogenital system, there is a common relation of ducts of the urinary and genital organs with the primitive cloaca.

The metanephros or kidney consists of two portions: (1) the secretory or glandular, and (2) the collecting system. The glandulotubular portion which comprises the glomerulus and the other portions of the nephron or secretory unit arises from the metanephrogenic blastema; the collecting portion or ureter is an outgrowth from the primary excretory duct. Growing dorsocranially, it finally presses into the metanephrogenic blastema where, by division, it forms the renal pelvis, calyces, and collecting tubules of the kidney; finally, the tissue of the renal blastema forms its nephrons and the lumen of these becomes continuous with those of the collecting tubules.

Primitively the ureters open on the dorsal wall of the mesonephric duct. As development progresses, each acquires an independent opening into the vesicourethral primordium which becomes the. . .



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