Embryology

Question 1

Weigert - Meyer Law in duplex kidney with complete ureteral duplication

Answer 1

Upper renal moiety ureter has ectopic insertion medial and inferior - associated with ureterocele
- in females : paradoxical incontinence if UO below sphincter
- in men: UO usually above sphincter

Lower renal moiety ureter has orthotropic insertion lateral and superior - reflux

Question 2

Kings classification megaureter

Answer 2

1. Refluxing - dysfunction of VUJ
2. Obstructed - functional obstruction or stricture of distal ureter
3. Refluxing and obstructed - no peristalsis in VUJ and reflux
4. Non refluxing and non obstructed - neonates : immature VUJ

Question 3

PUV MCUG findings

Answer 3

5:1 ratio posterior urethra (dilated posterior urethra- (keyhole sign)
Bladder trabeculations and diverticule
Hypertrophied BN (keyhole sign)
Reflux

Question 4

Persistent upper tract dilation in PUV

Answer 4

Supra vesical
- Renal dysplasia
-Nephrogenic DI : large urine volume
- VUR

Vesical
- Bladder dysfunction
- Valve bladder with ongoing VUR

Infravesical
- Persistent valves needing repeat ablation
-Stricture associated with previous ablation
- Bladder neck hypertrophy

Question 5

Features of Duplex on KUB U/S

Answer 5

Enlarged kidney
Dilated proximal ureter and hydronephrotic upper moiety
Doppler demonstrates 2x renal pedicles