nephro-urology study day 4 july 2017 · nephro-urology study day 4th july 2017 interactive case...
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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
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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
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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
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Panel discussion
What are the management options?
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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
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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
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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
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Cystoscopic ureterocoele puncture
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Managment
•Planned Cystourethroscopy
•Laser puncture of ureterocoele to decompress
•Urethral catheter post operatively
•Home day 2 post operatively
•USS follow up 3 months.
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JP
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Case 3
• 18 months old girl
• Normal antenatal scans
• 2 documented UTI around 1 year of age
• US renal tract
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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
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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
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Cystoscopy
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Retrograde study
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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
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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
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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
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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
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Summary
• 7yr old girl,
• Right duplex kidney, poorly functioning
upper pole and ectopic ureter.
• What are the management options?