Nephro-Urology Study Day

4th July 2017

Interactive Case discussions

4th July 2017

Southampton

Presenters

C Jones

A Upasani

MDT Panel

Mr H Steinbrecher

Mr S Griffin

Mr S Manoharan

Reassura

nce a

nd follo

w u

p

Renal tra

ct U

S

Referr

al to

tert

iary

centre

32%

7%

61%

Case 1: 3 year old girl referred with day and night

wetting. No UTIs. What is the appropriate

investigation?

Detailed History +

Normal Examination

A. Reassurance and follow up

B. Renal tract US

C. Referral to tertiary centre

Non inva

sive b

ladder a

ss...

EUA + cy

stovag

inosc

opy

CT Uro

gram

MR u

rogr

am

11%

35%

16%

38%

History: Girl is dribbling urine continuously.

Previous imaging: R kidney: upper pole cyst. Disappeared

What is the next investigation?

A. Non invasive bladder

assessment

B. EUA + cystovaginoscopy

C. CT Urogram

D. MR urogram

Panel discussion

What are the management options?

Reassura

nce +

follo

w up

Renal tra

ct U

S on D

ay 1

Renal tra

ct U

S on D

ay 3

0%

77%

23%

Case 2: Male infant, term baby

Antenatal right moderate hydronephrosis.

What is the next investigation?

A. Reassurance + follow up

B. Renal tract US on Day 1

C. Renal tract US on Day 3

Urete

roce

le a

/w lo

wer .

..

Urete

roce

le a

/w u

pper...

69%

31%

What does the US show?

A. Ureterocele a/w

lower moiety

dilatation

B. Ureterocele a/w

upper moiety

dilatation

Reassura

nce +

follo

w up

Trimeth

oprim 2m

g/kg/d

...

Trimeth

oprim 2m

g/kg/d

...

0%

87%

13%

How would you manage this?

A. Reassurance + follow up

B. Trimethoprim 2mg/kg/d +

Rpt US & DMSA @3

mths

C. Trimethoprim 2mg/kg/d +

early repeat US at 10-14

days, with urology referral

Cystoscopic ureterocoele puncture

Managment

•Planned Cystourethroscopy

•Laser puncture of ureterocoele to decompress

•Urethral catheter post operatively

•Home day 2 post operatively

•USS follow up 3 months.

JP

Case 3

• 18 months old girl

• Normal antenatal scans

• 2 documented UTI around 1 year of age

• US renal tract

Obstru

ctio

n

Reflux

Obstru

ctio

n + R

eflux

Non obst

ruct

ing/

non reflu

x

Transie

nt hyd

ronephro

sis

18%

13% 13%16%

39%

What is the most likely cause for

hydronephrosis?

A. Obstruction

B. Reflux

C. Obstruction + Reflux

D. Non obstructing/non

reflux

E. Transient hydronephrosis

Mict

uratin

g Cyst

oureth

r...

Mag 3

Serial R

enal USSC

MCUG +

Mag 3

16%

49%

3%

32%

What would your next investigation

be?

A. Micturating

Cystourethrogram

B. Mag 3

C. Serial Renal USSC

D. MCUG + Mag 3

Cystoscopy

Retrograde study

Case 4

• 7 year old girl

• Urinary incontinence

• ?antenatal Right kidney abnormality – No postnatal imaging

• Potty trained aged 2.5yr

• Never completely dry

• 4-5 voids/day

• Constant dribble

• No urgency/frequency/UTIs

Antenata

l renal t

ract

a...

Never b

een dry

Continuous d

ribblin

g

All of t

he above

25% 25%25%25%

What are the features of the history that would

prompt further investigation/urology referral?

A. Antenatal renal tract

abnormality

B. Never been dry

C. Continuous

dribbling

D. All of the above

DMSA

Repeat USS

MR u

rogr

am

Cystosc

opy

25% 25%25%25%

What would be your next

investigation?

A. DMSA

B. Repeat USS

C. MR urogram

D. Cystoscopy

Scarr

ing o

f upper p

ole o

f ...

Reduced re

lativ

e funct

io...

Right d

uplex w

ith u

pper...

33% 33%33%

What does the DMSA demonstrate?

A. Scarring of upper

pole of left kidney

B. Reduced relative

function of Right

kidney

C. Right duplex with

upper moiety

reduced function

Summary

• 7yr old girl,

• Right duplex kidney, poorly functioning

upper pole and ectopic ureter.

• What are the management options?