CASE PRESENTATION

73 Year old patient referred to our center with gross haematuria.

Personal history:
-work accident 20 years ago with spinal cord injury- paraplegic,
permanent urinary catheter carrier, chronic constipation
-bladder stone surgery 10 years ago, no follow-up
-DM type 2-oral treatment, associated heart disease.

WHAT NEXT?
• ULTRASOUND
• CYSTOSCOPY
• CAT SCAN
UROGRAPHY
• ANTIBIOTICS
• CYSTOSCOPY+ULTR
ASOUND
4/4,3 cm right renal tumor, 4.6 cm diam. laterocaval adenopathy with central necrosis,
large bladder tumor with associated bladder stone, NO OTHER PARTICULARITIES

WHAT NEXT?
• RIGHT NEPHRECTOMY
• PARTIAL RIGHT NEPHRECTOMY
• CYSTOSCOPY
• RADICAL CYSTECTOMY
 CYSTOSCOPY
BLADDER STONE, BLADDER TUMOR >70% OF
BLADDER CAPACITY, APPARENTLY SUPERFICIAL,
GROSS HAEMATURIA.

WHAT NEXT?

• BIOPSY
• TRY COMPLETE TURBT+STONE
FRAGMENTATION+MMC
• BIOPSY + HAEMOSTASIS
• CYSTECTOMY
 BIOPSY + HAEMOSTASIS
WHAT NEXT?
• RADICAL NEPHRECTOMY WITH
TEMPLATE LDN
• PARTIAL NEPHRECTOMY
• RADICAL NEPHRECTOMY AND
LYMPHNODE FROZEN SECTION
BIOPSY
• TRY PARTIAL NEPHRECTOMY AND
LYMPHNODE FROZEN SECTION
BIOPSY

TRIED TRANSPERITONEAL PARTIAL NEPHRECTOMY,

INTRAOPERATORY FINDING pT3 tumor,
LND biopsy frozen section-RENAL PAPILARY
CARCINOMA-RADICAL NEPHRECTOMY+ TEMPLATE
LND
 NEPHRECTOMY PATHOLOGY: LOW GRADE RENAL
PAPILARY CARCINOMA pT3aN1 (single lymph node
metastasis)

BLADDER BIOPSY-pT1G3

WHAT NEXT?

• TRY COMPLETE RESECTION+MMC

• RX + CHT
• RADICAL CYSTECTOMY
• NEOADJUVANT CHT + RADICAL CYSTECTOMY
PATHOLOGY
• UROTHELIAL HIGH GRADE CARCINOMA (G3) WITH
SQUAMOUS METAPLSIA AND LVI+, pT1N0M0.

WHAT NEXT?

• ADJUVANT CHT
• ADJUVANT RX+CHT
• FOLLOW-UP
• ADJUVANT RX