DR.

SUSHIL KARIA
MS, FRCS (ENGLAND),
FRCS (EDINBURGH),
FRCS (GLASGOW)
COUNSULTANT UROLOGICAL SURGEON
ANISH INSTITUTE OF KIDNEY DISEASES
B.T.SAVANI KIDNEY HOSPITAL
H.J.DOSHI HOSPITAL & RESEARCH CENTRE
RAJKOT
PRESIDENT ELECT
GUJARAT STATE SURGEONS ASSOCIATION

SPECIAL INTEREST :
URO-ONCOLOGY & RENAL TRANSPLANT SURGERY
ASSOCIATE PROF. UROLOGY AND SURGERY, CUSMC
 Malignant Tumors
Wilm’s Tumour:- Nephroblastoma
- Epithelial + Connective Tissues
- Arising from embryonic Nephrogenic tissues

Male – Female:- 2 : 1
New born, Foetus, Children – Up to – 3
Bilateral
 Pathology:-
- Macro
- Grayish white or Pinkish white
- Consistency firm to soft
- Cystic degeneration, hemorrhage
 Micro
- Epithelial Tissue
- Connective tissues ( Mesenchymal)
- Occ
- Cartilage
- Bone
- Smooth or Striated Muscles
- Primitive sarcomatus spindle cells, embryonic
round cells and Tubules
 Symptoms
- Mass, Pyrexia, H’uria
- Pain
Hemi hypertrophy of Body, Congenital absence of
Iris (Rare)
 Metastases
- Lungs
- Liver
- Occ – Bones & Brain
- Lymphaties – Para aortic
- D/D Retroperitoneal Neuroblastoma, Sarcoma
- TREATMENT:
- Nephrectomy
- DX”RT
- Chemotherapy – Actinemycin D
– Adriamycin
 Tumours of Renal Pelvis
Papillary Renal Tumours:-
- H’uria
- Clot colic
I. V. P
- Chracteric filling defect in renal Pelvis
Nephro – Ureterectomy
 Rare
(1) Squamous cell carcinoma
- Associated with Leukoplakia – in stone diseases

(2) Adenocarcinoma of Renal Pelvis with stones

 GRAWITZ TUMOUR
Renal Cell Ca
Adeno-Carcinoma
Hypernephroma
 Pathology
Macro:-
- Varigated appearance
- Spherical
- Hemorrhagic areas + cystic Necrosis
- divided in to various lobules by fibrous septas
- Cross Section:-
- Characteristically yellowish due to lipoid
deposition.
- Dull white or Semi Transparant
- Congested veins ++
- Rounded yellow, varigated appearance
- Occ. Calcification. Bone cartiladge
 Microscopy
- Solid alveoli of cuboidal or polyhedral clear cells.
- Deeply stained small rounded nuclei.
- Cytoplasm Contains:-
- Glycogen
- Lipids
- Cholesterol
- Clear & Dark cells eosinophilic, grannularar
- Rich large blood vessels
 Metastasis
Lungs – Canon Ball appearance
Bones
Lymphaties
- Von Hippel’s disease – Ratinal Angiomatosis
- Amyloidosis may be present
Clinical Features
Male > Female
2 : 1
- H’uria
- Pain
- Fever
- Policythaemia, Gen. Weakness,
- Endocrine disturbances – Rennin Secreting
- INCIDENTIAL
An abdominal CT
a without and b with Niopam
contrast, indicating a renal
tumour of the left kidney (red
arrow) with a necrotic centre
(blue arrow), and a regional
lymph node (black arrow
Prostate Cancer
Prognosis – the main prognostic factors are
histological grade and stage, as well as serum PSA
levels at presentation. The main prognostic criteria used
in pathological staging, following radical prostatectomy
for localized disease, are tumour volume, grading,
extracapsular extension and lymph node involvement
Treatment
Localized disease
Watchful waiting
Radical radiotherapy:
Surgery: radical retropubic or perineal prostatectomy offers a good prospect of
cure for organ-confined cancer and to achieve local disease control.

Locally advanced disease

External beam irradiation
Hormonal treatment
Metastatic disease
Orchidectomy:

Oestrogen

LHRH agonists

LHRH analogues

Steroidal anti-androgens:

Non-steroidal anti-androgens

Maximal androgen blockade:

Palliation
 CARCINOMA BLADDER

• 55 YEAR OLD MAN PRESENTED WITH

THREE EPISODES OF HAEMATURIA IN
2 MONTHS TIME.
• SONOGRAPHY REVEALED 3 CMS SIZE
BLADDER MASS ON LT. LATERAL
WALL
• 60 year old
male
presented with
painless
hematuriya
and USG
shows 3 cm
size bladder
mass
• DO WE NEED MUSCLE BIOPSY
ALONG WITH THE TUMOUR ?

• IS ONLY TISSUE DIAGNOSIS

SUFFICIENT ?

• WHAT IS YOUR SUGGESTIONS

FOR THIS PATIENT’S
MANAGEMENT ?
 CA.BLADER

• CYSTO
URETHROSCOPY
• BIOPSY
• SUPERFICIAL
TUMOUR
• INVASIVE
 Carcinoma Bladder:
For superficial T.C.C.:
 
Intra Vesical installation of :
B.C.G.
Epirubicin
Mitomycin-C
Doxorubicin
 
Newer agents for palliation:
Placlitaxe
Ifsfamide
 TAKE HOME MESSAGE
• COMPLETE RESECTION WITH
MUSCLE TISSUE IS A MUST IN CASE
OF RESECTABLE BLADDER TUMOR
• TRANS URETHRAL BIOPSY CAN BE
TAKEN IN CASES OF ADVANCED
MALIGNANCY FOR DIAGNOSIS
• ONLY CUP BIOPSY IN BLADDER
TUMOUR IS NOT SUFFICIENT FOR
COMPLETE DIAGNOSIS
1. INVESTIGATIONS
2. HAEMETURIA
3. URINARY TRACT INFECTION
4. URETERIC COLIC
5. URINARY STONE DISEASE
6. BENIGN PROSTATIC HYPERPLASIA
7. MALIGNANT PROSTATE
8. URINARY TRACT TRAUMA
9. STRICTURE URETHRA
10. PAEDIATRIC UROLOGY:
New born Hypospedias PUJ Obstruction
Congenital Hernias and Hydrocoele
ACUTE TORSION OF TESTIS
 
MANY MORE COMMANDMENTS FOR
SPECIALISTS AND SUPER SPECIALISTS

Like:
PAEDIATRIC UROLOGY-RENAL TRANSPLANTS-INFERTILITY
LAPAROSCOPIC SURGERY
• Haematuria
• Upper tract imaging: ultrasound plus KUB
(kidneys, ureter and bladder) radiograph or
intravenous urogram (IVU)
• Full blood count plus urea and electrolytes
• Mid-stream urine for microscopy, culture
and sensitivity
• Urine cytology
• Cystoscopy – flexible or rigid
• NB All cases must have upper tract imaging
and cystoscopy
Causes of haematuria

Glomerular

•  IgA nephropathy

•  Mesangioproliferative glomerulonephritis

•  Focal segmental glomerulonephritis

•  Familial nephritis (Alport’s)

•  Membranous glomerulonephritis

•  Systemic lupus erythematosus

 Non-glomerular medical
•  Blood dyscrasias (haemophilia, thrombocytopenia) •
 Sickle cell disease
•  Polycystic renal disease
•  Papillary necrosis
•  Renovascular disease
•  Infections (bacterial, tuberculosis, schistosomiasis)
•  Drugs (anticoagulants, cyclophosphamide,
penicillamine)
•  Exercise-induced haematuria
Non-glomerular surgical

•  Renal tumour (adenocarcinoma)

•  Urothelial tumour

•  Prostate (benign prostatic hyperplasia,

adenocarcinoma)

•  Urolithiasis

•  Trauma (blunt, penetrating)

History
Examination
Abdominal palpation
External genitalia:

Investigations
Urinalysis:
Urine cytology:
Other urine markers:
Renal function:
Imaging
 Management of Acute Haemeturia:
•Painful haemeturia can be due to infection, stone disease ,trauma
or underlying other pathology.
•Investigate at your clinic only.
•Then refer patient to specialist for further management.
•There is no point in sending patient in emergency, unless patient is
loosing massive amount of blood.
•Painless, frank , haemeturia needs special consideration to rule out
underlying malignancy.
•Cystoscopy must be performed.
•C.T.Scan SOS.
•Definitive treatment like TUR BT, Radical Cystectomy, or Radical
Nephrectomy should be performed only by specialist at specialist
center.
•Follow up check cystoscopy can be performed at periphery by
roaming urologist.
•Stone surgery as discussed later on/ previously.
Retention of Urine
Management of Acute retention of Urine:
•Proper aseptic precaution.
•Use good quality catheter.
•Do not keep attepting catheterization.
•No need of heavy antibiotics.
• No emergency blind dilatation of sticture urethra.
•Put supra pubic catheter.
• No open supra pubic as far as possible.
•Atleast aspirate urine with a wide bore needle from supra pubic
region before sending the patient to specialist.
•Examine patient for P/R after catheterization.
•Investigate patient for renal tract and cardiac problems before
reference.
Management of chronic retention of
urine: (Retention with over flow )
Long term urethral catheterization.
preferably supra pubic catheter.
Slow decompression of bladder is not really
necessary.
Further management by specialist.
Urodynamic study SOS.
Proper catheter care of long term catheter is a must.
Here your roaming urologist colleague can be of great
help during his regular visit.
Effects of bladder
outflow obstruction
on the bladder and
upper tracts
Early changes
Normal upper tracts
•Small residual urine after voiding
•Hypertrophied detrusor (thick-walled
bladder on intravenous urogram,
trabeculation at cystoscopy)
•Saccules

Late changes
Hydroureter
Chronic retention of urine predisposing to infection
Hydronephrosis (obstructive uropathy)
Obstructive nephropathy
Atonic detrusor
Diverticulum
Stones
 THANK U

ANISH HOSPITAL