DANARTO

URINARY TRACT TUMORS

RENAL CELL CARCINOMA

The classic triad associated with renal cell

carcinoma ( hematuria, flank pain, and flank
mass ) is rare seen. Hematuria is the most
common initial finding whereas a palpable flank
mass accompanied by pain is seen in less than
1/3 of such patients.
Refinement in the use of CT scanning has
virtually eliminated the usefullness of sonografi.
However, sonography maybe applied in
percutaneus needle aspiration of a cystic
structur in order to obtain fluid for cytology and
to inject contrast to outline the inner profile of
the cyst.
 Hematuria

Intravenous pyelography

Renal mass

CT scanning with contrast enhancement

Cystic mass Solid mass

Clear fluid Hemorrhagic fluid Benign Malign

TRANSITIONAL CELL CARCINOMA OF THE BLADDER

The commonest presenting symptoms of transitional cell

carcinoma of the bladder are hematuria and irritable
voiding ( urgency, frequency, dysuria ).
Evaluation should include intravenous pyelography, urine
cytology, and cystoscopy; abnormalities in any of these
should prompt cystoscopy with anesthesia.
Cystoscopy should include a transurethral resection of the
tumor, usually with sampling of the bladder muscular wall,
and examination under anesthesia. It may be appropiate
to sample multiple areas of mucosa to identify multifocal
in situ carcinoma.
 Hematuria or irritable voiding

History IVP
Physical Examination Cytology,Cystoscopy

Any abnormality in test results

Cystography

Normal Mass in the bladder

May be infektions Bladder tumor

Therapy Rever urologist

CARCINOMA OF THE PROSTATE

Carcinoma of the prostate is the third most frequent

cause of cancer in males. Most patients present with
advanced disease, either extending beyond the
confines of the prostate or metastatic to regional and
distant lymph nodes. Staging is essential to ensure
proper therapy.
Patiets with prostatic carcinoma often present with
symptoms of bladder outlet obstruction similar to
those of benign prostatic hyperplasia.
Patients with bony metastases may present with
bonee pain ; in other patients, a prostatic nodule or
indurated area is detected on routine rectal
examination.
Physycal examination is an essential part of evaluation
of the patient with carcinoma of the prostate. The
gland is usually irreguler : a hard area may be present.
Attempts should be made to determine if the nodular
area involves one or both lobes of the prostate and if it
extends to the periprostatic tissues or around the
seminal vesicals.
Should the prostatic nodule change in character,
repeat biopsy is likely indicated. Prostatic needle
biopsies are only 80 % accurate and report biopsy is
indicated if the clinical suspicion of malignancy
remains.
 Prostatic enlargement

History and physical examination

Assess extent of enlargement

Prostatic nodule or Diffuse enlargment

Induraion
Rever Urologist

Prostate biopsy
Benign prostatic hyperplasia

Negative Positive
CARCINOMA OF THE PENIS

Carcinoma of the penis should be suspected in the

patient with a persistent lesion of the gland penis,
foreskin, or shaft of the penis, especially one arising
close to the coronal sulcus or head of the penis.
The ffending lesions may be an ulcer, an indurated
area that fails to heal, or an exophytic fungating mass
that bleeds and is painful. Larger, more overt lesions
often are associated with purulent discharge and are
exceedingly malodorous. Most of these lesions occur
in elderly uncircumcised men who may present with
the sole complaint of slight bloody or yellowish
discharge.
The diagnosis is confirmed by biopsy. The tissue specimen
should include the margin of the lesion along with
contiguous tissue to ascertain the extent of disease.
If the lesion appears confined to theprepuce, circumcision
constitutes an adequate biopsy and may also represent a
definitive therapeutic effort. If the initial biopsy is positive,
usualy squamous or epidermoid carcinoma, regional
lymph nodes should be evaluated.

The penile amputation should be 1 cm proximal to the

margin of the lesion.
 Carcinoma of the penis suspected

Penile lesion

History and physical examination Palpation of nodes

Biopsy

Benign Malign

Penectomy

Inguinal lymph node desection

TESTISCULAR MASS

Testicular tumors are rare and account for 1 % of all

malignancies in men. They are the commonest cancer
in young men and the third leading cause of death in
that group. The exact cause of testicular cancer
remains unknown. A familial tendency towords tumor
occurrence, the infrequency incidence in blacks ( 12 –
15 % of the incidence in white ), and the increased
incidence in the cryptorchid testicle.
Ten to 15 percent of all patients have a history of
scrotal trauma, there is no evidence to implicate
trauma as a causative factor. Ten percent have
symptoms referable to metastatic disease as their
initial complaint. Two percent are bilateral and
gynaecomastia may occur.
The serum tumor markers aiphafetoprotein ( AFP )
and human chorionic gonadotropin ( HCG ) provided
a way to follow the course of these patients.
 Solid testicular mass

History and physical examination Serum markers ( AFP, HCG )

Radical orchiectomy

Germinal cell tumor Non germinal cell tumor

Seminoma Non seminomatous germ

(Normal AFP) cell tumor

Radiation therapy Treatment isstage-dependent

BPH (BENIGN PROSTATE HYPERTHROPHY)
ANATOMY
TURP
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