Renal Pelvis

Question 1

Basic workup for renal pelvis mass?

Answer 1

Imaging of the upper tract system
Cytology
Cystoscopy
Ureteroscopy and biopsy and/or selective washings
Renal function tests
CXR
CBC
Nuclear medicine renal scan is optional
Bone scan if indicated
Family history: high risk - consider evaluation for Lynch syndrome (<60 at presentation, personal history of colon/endometrial cancer)

Question 2

Is nuclear medicine renal scan a must in the workup of renal pelvic masses?

Answer 2

No

It’s optional

Question 3

Are renal function tests routine?

Answer 3

Yes

Question 4

When do you request bone scan?

Answer 4

When there are symptoms

Question 5

What will you consider in patients who are <60 at presentatation, and with personal history of colon/endometrial ca?

Answer 5

Lynch syndrome

Question 6

For metastatic renal pelvic masses, what is the next step?

Answer 6

Systemic therapy

Question 7

How are renal pelvic masses graded?

Answer 7

Low grade and High grade

This is based of the WHO/International Society of Urological Pathology recommended grading system

Question 8

What are the options for non metastatic, low grade renal masses?

Answer 8

NEPHROURETERCTOM WITH CUFF OF BLADDER WITH OR WITHOUT PERIOPERATIVE INTRAVESICAL CHEMOTHERAPY

OR

ENDOSCOPIC RESECTION WITH OR WITHOUT POSTSURGICAL INTRAPELVIC CHEMOTHERAPY OR BCG

Question 9

What are the options for intrapelvic treatment post endoscopic resection?

Answer 9

BCG

MITOMYCIN GEL

Question 10

For high grade, large, or parenchymal invasive non-metastatic renal masses, is endoscopic resection an option?

Answer 10

NO

Question 11

What is the difference between nephroureterectomy with cuff of bladder surgery in low grade and high grade non-metastatic renal pelvic masses?

Answer 11

HIGH GRADE LESIONS REQUIRE REGIONAL LYMPHADENECTOMY

Question 12

Is neoadjuvant chemotherapy an option in high grade/large or parenchymal invasion?

Answer 12

MAY BE USED IN SELECTED CASES