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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

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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

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± 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

SymptomsSymptomsSymptomsSymptoms : - Hematuria

- Flank pain

- Abdominal/flank mass

Others: Varicocelle / Lower extremity oedema

ParaParaParaPara----neoplastineoplastineoplastineoplasticccc symptomssymptomssymptomssymptoms:

Increased LED / LDH / Ca+

Unexplained fever

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

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Clear cell / conventionalClear cell / conventionalClear cell / conventionalClear cell / conventional 70 70 70 70 ---- 80%80%80%80%

Papillary 10 - 15%

Chromophobic 4 - 5%

Collecting duct < 1%

Medullary cell < 1%

Oncocytoma 3 - 7%

TreatmentTreatmentTreatmentTreatment : : : :

� Nephron-sparing surgery

� Radical Nephrectomy

� Chemotherapi

� Immunotherapi

Lung 29 – 54 %

Bone 16 - 27 %

Liver 2 - 10 %

Brain 1 – 7 %

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About ± 5-7% of all renal tumors

90% are TCC90% are TCC90% are TCC90% 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 :Risk factors :Risk factors :Risk factors :

Chronic infection

Long standing stone

Analgesic abuse

Smoking

Occupation (chemical, petroleum, plastic, coal,

asphalt)

Exposure to cyclophosphamide (alkylating agent)

Diagnostic :Diagnostic :Diagnostic :Diagnostic :

History : hematuria, pain/colic

Urine cytology

Imaging : KUB/IVU, CT Scan

Endoscopy : RPG, Cystoscopy, URS (biopsy prn)

Staging : Chest X-ray, Bone Scan

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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

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SymptomsSymptomsSymptomsSymptoms : Hematuria 85 – 90 %

Dysuria, frequency, urgency

DiagnosisDiagnosisDiagnosisDiagnosis :

Urine cytology

Imaging: USG / KUB & IVU / CT-SCAN

Cystoscopy/TUR & biopsy :

- Tumor size

- Location / single or multiple

- Tumor base biopsy

Based onBased onBased onBased on ::::

Tumor type/grade/stage/size

Primary/recurrence

Location

Focality

Co-morbidity

Intra vesical Chemotherapi

Transurethtral Resection of Baldder Tumor

Radical Cystectomi

Radiotherapi

Chemotherapi