UROLOGY SUB DIVISIONDEPARTMENT OF SURGERY

MEDICAL SCHOOLUNIVERSITY OF SUMATERA UTARA

I. RENAL TUMORS

A. Grawitz Tumor

B. Wilms Tumor

ll. UPPER URINARY TRACT.

TUMORS

(Pelvio-calyces system &

Ureter)

III. BLADDER TUMORS

IV. TESTICULAR TUMORS

V. PROSTATE CANCER

VI. PENILE CANCER

RENAL TUMORS

A. Simplified classification of renal tumors:

Benign tumors cystic lesion, oncocytoma, angiomyolipoma (AML)

Malignant :

- Nephroblastoma (Wilms’ tumor)

- Renal Cell Ca (adenocarcinoma, “hypernephroma”)

B. Renal masses classified by pathology of Renal Tumors

c. Renal masses classified by radiographic

appearance

Simple cyst

Complex cyst

Fatty tumors (AML)

All others:

- Oncocytoma

- Renal cell ca ect.

A benign renal neoplasm

It is composed of variable amounts of fat, vascular, and smooth muscle elements

The fat density of the tumour on CT has been regarded to be pathognomonic

It occurs in more than 50% of individuals with tuberous sclerosis, often bilaterally. Angiomyolipomata also occur in 40% of women who have a rare, cystic lung disease called lymphangioleiomyomatosis, or LAM.

Tumor < 4 cm can be observed

Nephrectomy in patients with acute or

potentially life-threatening hemorrhage

Selective embolization in patients with

bilateral disease

± 3% of all adult malignancies

Male: Female: 3 : 2

6th and 7th decade of life, uncommon in childhood

Renal cell carcinoma arise from the renal epithelium and account for about 85 percent of renal cancers

A quarter of the patients present with advanced disease, (mRCC)

A third of the patients who undergo resection of localized disease will have a recurrence

Incidental findings on USG

Symptoms : - Hematuria

- Flank pain

- Abdominal/flank mass

Others: Varicocelle / Lower extremity oedema

Para-neoplastic symptoms:

Increased LED / LDH / Ca+

Unexplained fever

CBC, metabolic panel (ESR, LDH, Ca+ )

Urinalysis

Abdominal/pelvic ultrasound / CT or MRI with or without contrast depending on renal function

Chest imaging

Bone scan, if clinically indicated

Brain MRI, if clinically indicated

If urothelial carcinoma suspected, consider urine cytology, URS or retrograde pyelography

Consider needle biopsy, if clinically indicated

Clear cell / conventional 70 -

80%

Papillary 10 - 15%

Chromophobic 4 - 5%

Collecting duct < 1%

Medullary cell < 1%

Oncocytoma 3 - 7%

Treatment :

Nephron-sparing surgery

Radical Nephrectomy

Chemotherapi

Immunotherapi

Lung 29 – 54 %

Bone 16 - 27 %

Liver 2 - 10 %

Brain 1 – 7 %

About ± 5-7% of all renal tumors 90% are TCC, 9% squamous cell ca TCC of the renal pelvis is 3-4 times more

frequent than TCC of the ureter : = 3-4 : 1 Incidence increases with age, peaks

during 6th - 7th decades 50% of ureteral tumors are multicentric 5-years overall survival rate is

significantly related to tumor stage

Risk factors: Chronic infection Longstanding stone Analgesic abuse Smoking Occupation (chemical, petroleum, plastic,

coal, asphalt) Exposure to cyclophosphamide (alkylating

agent)

Diagnostic: History: hematuria, pain/colic Urine cytology Imaging: KUB/IVU, CT Scan Endoscopy: RPG, Cystoscopy, URS

(biopsy prn) Staging: Chest X-ray, Bone Scan

Ureterectomy (resection & anastomosis) in selected cases whenever possible

Nephro-ureterectomy Endoscopic management Instilation therapy

Most common malignancy of the urinary tract

Male > Female 75-85% of patients with bladder cancer

present with disease confined to the mucosa

The average age at diagnosis is 65 years

Aromatic amines Smoking Trauma to the urothelium induced by

infection, instrumentation, and calculi Genetic

TCC 90 % SCC 5 – 10 %

Adeno Ca 2 %

Sarcoma

PUN LMP

Undifferentiated

Unknown

Symptoms: Hematuria 85 – 90 % dysuria,frequency, urgency

Diagnosis: Urine cytology Imaging: USG / KUB & IVU / CT-SCAN Cystoscopy/TUR & biopsy:

- Tumor size- Location / single or multiple- Tumor base biopsy

Based on:

• Tumor type/grade/stage/size• Primary/recurrence• Location• Focality• Co-morbidity

Intra vesical Chemotherapi Transurethtral Resection of Baldder Tumor Radical Cystectomi Radiotherapi Chemotherapi