UROLOGY

SUMMARY OF

INDEX
URINARY STONES
HYPER-NEPHROMA
WILM’ S TUMOR
BENIGN PROSTATIC HYPERPLASIA
CANCER PROSTATE
CARCINOMA OF UB
RENAL TRAUMATOLOGY
CONG. POLY CYSTIC KIDNEY
MISCELLANEOUS if you found it useful
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 ETIOLOGY Types

· All stones are RO except PURE UA (Radio-lucent)

METABOLIC STASIS INFECTION · All stones are in ACIDIC urine except PH. (alk. urine)
· All stones are HARD except PH. (friable dt infection)
(2RY STONE) · All stones are LAMINATED except PH. (amorphous)
1) Hyper-calcuria.
· Prolonged recumb. · Disturbed cryst. / colloid ratio
2) Oxaluria. · All stones are SMOOTH except OXALATE (spiky)
· Stricture. · Ulceration of mucosa ® dark brown in color dt bl. pigment
3) Uricosuria
(Tumor lysis $ - Gout) ® nidus ® Stone formation. ® early symptoms "hematuria" ® small stones.
NB: TRIPLE PH. STONE = ammonium, Mg. Ca salts.
enlarges rapidly filling the renal calyx. "STAG-HORN STONE"

Invest. Complications

"CLASSICAL" "OMUMI"
1) URINE A. ® Pus, RBCs, Crystals, C&S. 1) Obstruction ® back pressure
· Hydrourter - Hydronephrosis.
2) KFTS. · Calculus anuria.
3) PXR ® 90% of urinary stones are RO. · Acute Retention in stone urethra.

4) US ® · Radio-lucent stones. (10%) 2) Migration ® recurrent attacks of ureteric colic.

in kidney, UB & upper ureter. 3) Ulceration ® haematuria.
· Hydro-nephrosis. 4) Metaplasia ® SCC on top of leukoplakia.
5) IVP ® as US + asses Kidney function. 1
5) Infection ® pyelo-nephritis, pyonephrosis & Cystitis.
 OF STONE
PREVENT
RECURRENCE

CONSERVATIVE FOR 2 WKS INSTRUMENTAL SURGICAL BY STONE ANALYSIS

1) Ph. ® Acidification by vit. C.
2) Ox. ® NaHCO3 + Thiazides
OBSELETE?!! (¯Ca in urine) + Citrates.
EXPLUSION NOT Opp. to indications of if failed or # 3) UA ® NaHCO3 + Allopurinol
5 CRITERIA Conserv. or failed??
DISSOLUTION instrumental ttt
1) 6 wks. & no expulsion.
· Small < 6mm. · Ample of fluids or diuretics.
2) No advance of stone 1) Kidney ® Nephrolithotomy.
· Smooth surface. · Analgesic & Antispasmodic. after 2 wks. by X-ray.
· No distal obst. (during the attack) 2) Pelvis ® Pyelolithotomy.
· No infection. · Antibiotics if UTI dt stone migr. 3) middle 1/3 ® Uretero-lithotomy.
· Good KFs. (IVP) · Follow up ® P X-ray weekly. 4) Bladder ® Suprapubic cystolithotomy.
5) Urethra ® Urethrotomy.
SPECIAL PROBLEMS
BI-LATERAL RENAL STONE STAG HORN STONE MULTIPLE LEVEL STONES
SAVE 1ST THE BETTER KIDNEY FUNCTIONING (IVP) EXCEPT: · Combined ESWL & PCNL. · Relieve lower obst. 1st as it leads to more damage.
· Pain on one side. · If failed ® Pyelo-nephro-lithotomy. · Urethra then Ureter then Kidney the last is Bladder.
· Pyonephrosis on one side.
· If uni-lat. in non-functioning kidney
· Bi-lateral stag horn stone (if asymptomatic + No ® Nephrectomy.
infection + HR pt.) ® Only conservative. 2
 KIDNEY STONE URETERIC STONE UB STONE URETHRA
ASYMPTOMATIC. AS KIDNEY + 5 SITES OF IMPACTION ASYMPTOMATIC ACUTE RETENTION OF URINE
P AIN MAINLY: 1) PUJ. 1) Frequency: “Earliest” Signs:
2) Crossing the Iliac a. · More by day dt trigonal irritation.
· Dull aching pain in loin. · Supra-pubic tenderness
3) Juxta-position of vas or · Later ® day & night from cystitis. & dullness.
· Uretric colic ® NV (so sever)
broad ligament. 2) Bladder pain:
ü Stone coming out of kidney ® loin. · Stone in prostatic
4) Intra-mural part. · Dull supra-pubic referred to tip of penis.
ü Upper ureter ® thigh – scrotum. urethra ® felt by PR.
5) Ureteric orifice. · S. pain at end of mictur. dt UB contraction.
ü Lower ureter & UB ® tip of penis. · Stone in penile urethra
(children rub their penis after micitur.) 3) T. hematuria dt UB contr. over ! stone.
® felt under surface.
· Stabbing pain ® dt oxalate stone. Ø SYMPTOMS OF THE CAUSE EG. BPH.

Investigations = Classical +
· Cystoscopy ® stone may 1) Cystoscopy ® stone + pathology (B). 1) Urethroscopy.
be seen peeping through 2) Click on Sounding.
2) Click on Sounding ® not felt if:
the ureteric orifice.
· Stone in diverticulum. 3) P-X ray:
· Stone in post. prostatic pouch. · ANT. URETHRA ® BELOW SP.
· POST. URETHRA ® BEHIND SP.

Treatment: SCHEME + SPECIFIC

LOWER 1/3 :
Urethra
ESWL PCNL if · < 1.5 cm ® Dormia basket. < 2 CM > 2 CM
· > 1.5 cm ® USL + extraction
by Dormia basket. Penile Prostatic
UROLOGIC # NON-UROLOGIC # · Stone > 2 cm.
USL or Trans- Open
· # of ESWL. · MIDDLE 1/3 ® Push bang or USL
urethral lithopaxy Cysto-lithotomy Push it up by
as # of Conserv. Absolute ® Preg. IF FAILED ® OPEN URETERO-LITHOTOMY. Crocodile
· Failed ESWL.
except if > 2 cm. forceps. sound to UB
Relative ®
or Stone lower · UPPER 1/3 ® Push bang + Then fragments are ¯
Kyphosis deformity lavaged outside by
calyx. or bl. tendency. ESWL insitu.
Ellik’s evacuator. 3
manage as stone
UB to relive ! obst
 BENIGN PROSTATIC H.
INCIDENCE 50 % of males > 50 ys.
ETIOLOGY hormonal imb. bet. (E) & Androgen
SITE Transition “peri-urethral” zone
· Middle ® elevates ! UB trigone.
MAC. · Lat. lobes both sides of urethra.
· Tri-lobar enlargement.
MIC. · Fibro-myo-adenoma. (SM glands)
· Adenosis, epitheliosis, fibrosis.
SPREAD 2 X 2: COMPLICATED PROSTATISM
/ COMP. · Acute retention ppt. by ”5W”.
· Ch. retention with over-flow.
(dt residual urine if pr. > urethra)
· Hydro ureter / Hydro-neph.
· Cystitis / Stone.
· Diverticulum / hematuria
dt rupture of SM congested veins.
MAINLY ASYMPT. (95%) / Triad of Prostatism
1) Night frequency & Urgency.
(later diurnal dt cystitis)
2) Diff. micitur.to Start (straining­cong. ® ­obst.) 3) Certain ® as BPH but rapid onset &
maintain (weak, forked, bet. legs)
progressive course; but PR = 3aks el 5S.
finish. (dribbling of urine)
3) Sexual ® early libido / late impotence.
SIGNS G = Uremia, fever.
A = Renal mass in hydro-neph.
L = PR ® (5S) Smooth, Soft, Sulci­,
Symmetrical, Sliding mucosa over rectum..
CANCER PROSTATE
M/C cancer in ♂ > 65 ys.
Long-standing Androgen Å
Peripheral zone
· Hard schirous nodule.
· Infiltrative.
· Adenocarcinoma. (Prostatic gl.)
· GLEASON’S SCORE. (SEE MISC.)
1) DIRECT ® pelvic organs, rectum is the last
to be involved dt fascia of Deninvier.
2) LYMPHATIC II LNs ® common iliac ® para
aortic ® thoracic duct ® virchow’s LN.
3) BLOOD ® lumbar vertebrae.
“osteo-sclerotic” dt com. bet. para-
vertebral & peri-prostatic venous plexus.
C/P
1) Path. ® as BPH + Discovered at biopsy
after enucleation. (histological surprise)
2) Doubtful ® as BPH + PR = hard nodule!
4) Occult ® Nothing except back pain dt
metastasis. (DD = disc prolapse)
DIFFERENTIAL DIAGNOSIS:
· BPH – CANCER PROSTATE.
· CHRONIC PROSTATISM – HEMATURIA.
WILM’S TUMOR HYPER-NEPHROMA
♂ < 4 ys. ♂ > 40 ys.
Embryonic “Totipotent” cells Cells of the PCT.
Upper pole / Bi-lateral (10%) Upper pole / Bi-lateral (1-2%)
LARGE MASS – SOFT RAPIDLY GR. INVADING MOD. MASS – HARD TO FIRM – COMPRESSING ! SURR.
· Early ® capsule. “mass” · Early ® pelvis. “hematuria”
· Late ® pelvis. · Late ® capsule.
· Pink color. · Golden yellow color + areas of HNC
· Epith. ® 1ry glomeruli & tubules. · Adenocarcinoma. (see types in misc.)
· CT ® cartilage, bone & ms. · Worst is mixed type.
1) DIRECT & BLOOD. “Early” 1) DIRECT ® to pelvis early.
2) LYMPHATIC. “Late” 2) LYMPHATIC ®Virchow’s LN.
3) BLOOD SPREAD
· embolization ® Canon ball 2ries
· Permeation ® malig. thrombus
in RV & IVC ® 2ry varicocele.
1) Early Abd. mass. 1) hematuria: early
SPINDLE · Total, causeless.
2) Late hematuria. SHAPED CHILD
· Painless, Profuse, Periodic.
· Cachexia + Slim chest.
2) Pain:
1) FUO.
· Dragging – dull ache – clot colic.
2) VAGUE ABD. PAIN dt hge inside tumor. · Later dt lumbar ns. infiltration.
3) HTN dt compression on renal vs.
® ischemia ® ÅRAS
3) Renal Mass. (see general)
4) ASS. CONGENITAL ANOMALIES. 4) 2ry varicocele / Metastasis / FUO.
· Macro-glossia – Aniridia. 5) Para malig. $ ® Renin – PRH – EP.
· Neuro-fibroma.
4
· Cryptochidism – hypospadias. (Triad occurs in 10% of pts. = inoperable)
 Treatment
BPH CANCER PROSTATE WILM’S TUMOR HYPER-NEPHROMA
ASYMPTOMATIC ® WAIT & WATCH. Operable ® Radical prostatectomy or Operable ® Radical Operable ® Radical Nephrectomy.
131
MAINLY CONSERVATIVE = AVOID “5W”: Radical Radio-th = EXT. BEAM OR I IMPLANT. Nephrectomy. (Abd. approach?) “Abd. approach” ?
same causes but no malig. thrombus. a) Early ligation of renal vs.
1) a blockers ® relax prostatic urethra. Inoperable:
b) Removal of malig. thrombus in IVC.
2) 5 a reductase (-) ® ¯ active androgen. 1) hormonal th.: Inoperable
c) Easily removal of huge tumor.
3) Phyto-therapy. · LHRH analogue ® “Zoladex” 1) Pre-operative Chemo / d) Dealing with infiltrated viscera.
SURGERY “ADENECTOMY” IF: · Comp. prostatism. · Estrogens ® Honvan (E + Phosphate) Radio-th. or both.
(tumor cells contain ACP ® releases (E)
Bi-lat. hyper-nephroma or in a solitary
retrograde ejac. dt · Interf. with life style. 2) Re-exploration if resectable. kidney ® partial nephrectomy + SM 2 cm.
injury of sph. vesicae · RU > 100 ml ® acts on tumor cells only)
Inoperable:
1) TURP “best” ® # if > 60 gm. 2) Palliative prostatectomy (TUR).
· Palliative nephrectomy.
(to avoid acute retention)
2) OPEN SURGERY ® TVP or Retro-pubic. · IL-2 & Interferon.

Investigations = “Classical” + Specific

1) UA + KFTs. 1) UA + KFTs ® RBCs + cytology for malig. cells.
2) Plain X ray ® metastasis or Corpora amylacea. 2) Plain X ray ® obliteration of psoas shadow, calcifications.
3) TRUS ® size. 3) US.
4) IVP ® elevated smooth filling defect at the bladder base. 4) IVP ®irregular spider leg app. (DEAD)
irregular in cancer prostate. 5) Triphasic CT scan:
5) SPECIFIC: a) Extent of tumor. c) Vascularity.
BPH CANCER PROSTATE b) LN infiltration. d) Malig. thrombus in RV & IVC.
a) Residual urine > 100 ml 1) Trans-rectal Biopsy.
Dx. metastasis à CT scan, US, bone scan
· Post-micturation IVP. 2) ACP & ALP. “bone metastasis”
· Sonar after voiding. NB: Biopsy is controversial (CT guided / FNC)
3) PSA > 4 suggestive. > 30 metastatic.
· Catheter after voiding. Recently Free / Total PSA?! ‫ ﺑﺎﻟﻌﻜﺲ‬:D ® peri-nephric hematoma.
b) PSA to exclude cancer.
4) Dx. metastasis ® CT / Bone scan. 5
 SCC (15%) TCC (80%)
AGE 20-40 > 60

SEX ♂: ♀ ® 4: 1 (Farmer with old B) ♂: ♀ ® 3: 1 (Citizen)

ETIOLOGY BILHARZIAL CYSTITIS ® Precancerous (see misc.) · Industrial carcinogenic:

Other causes: a) Analine dyes, petrol, leather.
a) Stone bladder. b) Rubber & textile.
b) Ectopia vesicae. · Smoking ® ­Risks. (4X)
c) Chronic cystitis other than B. · Anomalies of the bladder
SITE lateral & post. wall. (M/C) lateral & post. wall. (M/C)

MACRO 1) Fungating mass. 80% 1) Papillary mass. 90%

2) Infiltrating mass. 2) Other forms are rare.
3) Malig. ulcer.

MICRO Same as SCC

· Masses of Malignant cells.
TCC
· Central ® CELL NESTs of Keratin.
· Peripheral squamous. “epitheliod”

SPREAD “Late” dt fibrosis & calcification. “Early” as there is no fibrosis

1) DIRECT ® to pelvic structures, but limited post. to ! rectum dt fascia of denonvier.
2) LYMPHATIC ® Perivesical LNs ® ext. iliac & II ® common iliac ® para-aortic LNs.
3) BLOOD ® Very rare & late.

COMPL. · Ulceration, hemorrhage, infection. (asc. PN) main COD.

· Obstruction ® hydro-ureter, hydro-nephrosis – Retention of urine.
Cl./P

SYMPTOMS SIGNS
1) Recent aggrevation of Chronic cystitis.
· G ® CAM + Uraemia.
(burning micutrition, frequency & pyuria)
· A ® renal or
2) Pain suprapubic mass.
· Dull aching supra-pubic pain.
· Tip of penis.
· Dull ache at loin dt back pr.
· Sciatic pain. "sacral plexus inv."
2) Necroturia.
3) haematuria ® Total + painful in SCC. 6
® Painless in TCC
 SCC of UB TCC of UB
Invest. · Urine Analysis ® hematuria, Necroturia, Fishy odor + Cytology.
· Plain x-ray ® Only in bilharzial carcinoma ® bladder calcification.
WALLACE STAGING OF SCC · IVP: ® irregular filling defect + assess KF + back pr.
(BI-MANUAL EXAM. OF UB UNDER GA)
· US / CT scan ® asses operability.
· T0 ® No palpable mass.
· Cystoscopy + Biopsy “Gold standard”
· T1 ® mobile + no induration if UB wall.
TCC is classified into: Superficial TCC ® no invasion of the ms. layer.
· T2 ® mobile + induration.
Ms. invasion TCC ® invasion of the ms. layer.
· T3 ® mobile + extra-vesical spread.
· T4 ® fixed bladder mass. DX. METASTASIS ® CT SCAN – US – BONE SCAN.

Treatment of Cancer UB
Radical cystectomy SUPERF. TCC
• Whole bladder. • Local excision. (TUR)
• Overlying peritoneum + lower 2" of ureters.
• BCG vaccine “intra-vesical”.
• Block Dissection of of Int. & Ext. iliac LNs.
males: prostae, SV, VD.
Operable females: FT & ant. vag. wall. MS. INVASIVE TCC ® as SCC
Urinary diversion • Radical Cystectomy + Urinary diversion.
• Uretero-cutaneous. • Radical Radioth. ® Ext. beam or brachy th.
• Ileal conduit.
• Uretro-sigmoidostomy.
• Recto-vesico urethroplasty

Inoperable • Resectable ® Palliative cystectomy • Resectable ® Palliative cystectomy.

· LOCALLY ADV. • Irresectable ® Palliative Diversion.
• Irresectable ® Palliative Diversion or
· DX. METASTASIS.
Palliative Radio & Chemo-th ® CMV. 7
· LN ++

ETIOLOGY CL./P COMP.

· EXTRA-PERIT. RUPTRE
dt blunt trauma.
· INTRA-PERIT. RUPTURE DT: Triad of Signs Early (APC) Late
Penetrating Or blunt trauma in G ® Shock.
1) history of Trauma. 1) Traumatic Anuria from shock. 1) Nephroptosis ®
hydro-nephrotic kidney or child
Intra-peritoneal Extra-peritoneal 2) Perinephric abscess. dt tearing of supporting t.
dt little peri-nephric fat. 2) hematuria... absent in:
Insp. 2) HTN ® dt fibrosis
· Tear ® Small or superficial. 3) Pseudo-hydroneph.® accum.
Hemo-peritoneum. Bruises & ecchymosis of urine + blood in peri-nephric space. ® Ischemia ® ÅRAS.
PATHOLOGY: · Ureter ® avulsed or clot retentn. ¯ mov. e respiration. in loin. 3) RA aneurysm.
4) Peritonitis.
· Sub-cap. hematoma. (Small / large) · Anuria from s. shock. palpation Same but at the loin
TR, RT + G & R all over + 5) P. ileus dt retro-perit. hematoma.
· Tear. (Superficial / Deep). · Avulsion of the whole kidney.
swelling dt pseudo- 6) Clot retention.
· Avulsion. (of a pole / pedicle) 3) Renal pain & Clot colic. perc. Shifting dullness
hemato hydroneph. 7) Urinary fistula.
Auscult Silent abd.
Invest. Treatment

1) UA & KFTs ® RBCs. (micro & macrosopic) Closed injury Surgical

2) P X-ray ® fracture ribs + oblit. of psoas shadow +
elevated copula of diaph. dt sub-phrenic collection. CONSERVATIVE FOR 2 WKS EXPLORATION (ABD. APPROACH)
3) IVP ® Extra-vasation + asses both kidney f. · R & M. Indications & CONSERVE ! KIDNEY AMAP.
4) US & CT scan e contrast: · CBC / 12 hrs. · SMALL TEAR ® surgicell.
· Extravasation. / pathology. (see above) · US / 24 hrs for perinephric
OPEN INJ. (INTRA-PERIT. HGE) OR · LARGE TEAR ® vecrily mesh or omental patch.
· Rupture. (intra / extra-peritoneal) fluid collection. CLOSED INJ. E FAILED CONSERV. · ONE POLE LACERATED ® partial nephrectomy.
· Swelling in the loin. · Progressive shock.
· Asses both kidney functions. · ­ hematuria / ¯ Hb. · LACERATED + (N) OTHER KIDNEY ® nephrectomy.
· Mass in the loin /peri-nephric inf. · SOLITARY KIDNEY ® packing e gauze for 48 hrs. 8
 UB RUPTURE URETHRA RUPTURE
INTRA-PERITONEAL (20%) EXTRA-PERITONEAL (80%) EXTRA-PELVIC INTRA-PELVIC (M/C)
CAUSES Blow on a fully distended bladder Fracture pelvis. Trauma to perineum Fracture pelvis
“Saturday night injury” (kick or falling astride)
· Gun shots. · Instrumentations.
· Stab wound. · Endoscopic resection.

SITE Dome of the bladder Ant. wall of bladder or its base. Ant. urethra (penile) Post. urethra (prostatic / memb.)

EXTRA-VAS. Peritoneal cavity Plane bet. peritoneum & fascia SC extra-vasation extending to ! as extra-peritoneal rupture bladder
OF URINE transversalis = DEEP EXTRA-VASATION ant. abd. wall & only to upper + complete urethral tear & post.
thigh. “limited by Scarpa’s fascia” Pub-prostatic lig.

SYMPTOMS 1) Shock. 1) Urethral bleeding.

2) Supra-pubic pain. 2) Acute retention of urine.
· HX. OF
TRAUMA 3) No desire to micturation. 3) hematuria. 3) Perineal hematomoa. 3) DEEP EXTRA-VASATION
· PAIN. (urine in peritoneum) 4) Diff. to miciturate dt narrow 4) Sever perineal pain. 4) Sever hypo-gastrial pain.
4) Peritonism: space (50 ml)+ rupture ms. layer.
COMPLICATIONS: urethral stricture / COMPLICATIONS: bl. loss & hgic shock / ureth.
T, RT, Rigidity max. at hypo-gastr.
5) Fracture pelvis. fistula / peri-urethral abscess. stricture / Impotence / inj. of ext. sphincter
Distention, vomiting & constip.
Fullness in recto-vesical pouch Soft swelling in peri-vesical Prostate in its place. Floating prostate.
SIGNS (PR) & prostatic spaces.
1) Plain X-ray ® Ground glass app. 1) Plain X-ray ® fractured pelvis. 1) Plain X-ray.
INVEST. (urine in lower abdomen) 2) Catheter ® Urine + drops of bl. 2) Asc. Urethropgraphy ® extra-vasation.
2) Catheter ® Only few drops of blood. 3) IVP or Asc. cystography ® leak. 3) IVP ® for associated urinary injuries.

TTT. Emergency repair in 2 layers The same + Fracture pelvis Never 1ry repair as Catheter passage ® ­damage & infection
using absorbable sutures ¯
¯
MID-LINE SUPRA-PUBIC INCISION Supra pubic cyst-ostomy ® wait 3 wks. for spont. healing
Never plate & screw as extra-vasated
® Urine is evacuated ® Close bladder in 2 layers & follow up by cyst0-urethrogram ® if with stricture
® Foley’s catheter + Drain cave of Retzius.
urine causes Osteomyelitis.
· SUPRA-PUBIC CYSTOSTOMY ® to (-) UB ¯
9
contraction ® giving it time for healing. Repeated Urethral dilation
 ETIOLOGY · Failure of fusion between metanephros (kidney) & mesonephros (pelvis & collecting system)
® retention cysts ® Compression on renal tissue.
· It might be a part of cystic changes of the body. (lung – pancreas – liver)

PATH. · Both kidneys are enlarged with multiple cysts.

Cysts are communicated
· Cysts are not intercommunicated & not connected to renal pelvis.
in hydro-nephrosis.
· Cysts compress renal tissue ® pressure atrophy.

CL./ P · At birth ® Obstructed labor.

· Infantile type (AR) ® Uremia & renal rickets.
· ADult type: (AD) ® at 4th decade
- SILENT ASYMPT. ® SUDDENLY UREMIA. (M/ C PRESENTATION)
- Bilateral renal mass.
- Pain ® dragging or dull ache.
- Hematuria ® dt rupture of cyst in the renal pelvis.
- Hypertension ® dt compression on renal vs.

DD Hydro-nephrosis & Multi-cystic kidney. MULTI-CYSTIC KIDNEY:

· Non-hereditary. (unknown etiology)
INVEST. · UA & KFTs.
· Unilateral.
Irregular & DEAD in · IVP ® Bilateral regular spider leg appearance. · Pre-malignant.
hyper-nephroma · U/S ®multiple cysts. “of choice” · so TTT. is Nephrectomy.

TTT. 1) No Nephrectomy unless Renal Transplant is possible since its bilateral.

2) Rovsing operation. (rupture the cysts ® not beneficial)
10
 MISCELLANEOUS
BPH = CAUSES OF NIGHT FREQUENCY & URGENCY TCC of Renal pelvis
1) at Night dt warmth & lack of ms. pump. · Multi-centeric.
· Papilloma ® bleeding & pre-cancerous.
2) ¯ UB capacity dt encroachment of the middle lobe.
· Local implantation ® Ureter.
3) Residual urine in “post. Prostatic pouch”
· TTT ® Nephro-urterectomy = kidney + whole ureter.
4) Detrusor ms. hyper-reflexia.
5) Atony of the bladder.
6) Exposure of prostatic urethra to urine inside the UB ® desire. BILHARZIAL CYSTITIS ® PRECANCEROUS LESIONS
7) Urgency is dt stretch of int. sphincter ® sever desire. 1) B ova:
· Mech. irritation.
CANCER PROSTATE = GLEASON’S SCORE · Long standing cystitis.
· BNO + stasis.
· G1 Well diff. ® Gleason 2 – 4. 2) Infected Alkaline urine ® phosphatic encrustation cystitis + sq. metaplasia.
· G2 Mod. diff ® Gleason 5 – 6. 3) Nitrates in vegetables & drinking water ® excreted in urine ® acted upon
by bacteria ® N. nitroso compounds which are pre-cancerous.
· G3 poorly diff. ® Gleason 7 – 8.

· G4 ® Gleason 9 – 10.
anaplastic
PUJ OBSTRUCTION
· Etiology 1) Uretero-pelvic tumors, polyps or valves.
HYPER-NEPHROMA: PATHOLOGICAL TYPES 2) Cong. Stenosis.
· CLEAR CELL ® dt ­ glycogen & lipid content. 3) Motility disorder.
4) Aberrant renal vs. ® compressing the PUJ.
· GRANULAR ® full of mitochondria.
· Invest IVP ® dilated pelvi-calycal system + contrast suddenly stops at ! PUJ.
· MIXED (M/C) ® Granular + Clear type.
· TTT. · Functioning ® Reconstruction of pelvis. “Anderson Hynes op.”
· MIXED + SPINDLE CELLS ® most aggressive. 11
· Non-functioning ® Nephrectomy if the other kidney is (N).