Nephrolithiasis, bladder cancer, renal cell carcinoma

Question 1

What is Kidney stone Etiology?

Answer 1

-Stone formation occurs when normally soluble material (Ca, PO4, uric acid) supersaturates the urine and begins the process of crystal formation.

Question 2

What are the Risk Factors of calcium stones?

Answer 2

• History of prior calcium urolithiasis
• Family history of urolithiasis
• Diet
• Medications
• Hyperparathyroidism
• Hypercalcemia of malignancy
• Sarcoidosis
• Medullary sponge kidney

Question 3

Clinical presentation of Nephrolithiasis?

Answer 3

• Renal colic begins suddenly
• Severe unilateral flank pain– radiating to groin/testicle/labia (T10-S4 dermatome)
• Pacing, Rocking, Writhing, Constant movement unable to find position of comfort (contrast to peritonitis)
• Frequently with nausea, vomiting, diaphoresis
• Tachycardia, Hypertension
• Gross hematuria and dysuria/frequency/urgency
• May have CVAT but abdomen is unremarkable
• Testicles are not tender or swollen

Question 4

What is the diagnosis of Ureteral colic?

Answer 4

-Focused history; severe waxing and waning flank pain often radiating to the grown. (family history of calculi, duration and evaluation of symptoms)
-CVA tenderness
-Urinalysis shows microscopic or macroscopic RBC
-Creatinine may be elevated
Non-Contrast abdomen CT (stone protocol)

Question 5

What is Staghorn calculi?

Answer 5

Upper urinary tract stones involve the renal pelvis and extend into at least 2 calyces

Question 6

What is the Pathology of Bladder cancer?

Answer 6

Transitional cell carcinoma

Question 7

What is the Epidemiology of Bladder cancer?

Answer 7

• 90% >55yo
• Men have more incidence of bladder cancer than women
• Cancers are more common in caucasian – 2:1.

Question 8

What is the Risk factors

of Bladder cancer?

Answer 8

Cigarette smoking, Occupational exposures

Question 9

Signs and symptoms of Bladder cancer?

Answer 9

• Painless Hematuria (80-90%)
• Urinary voiding symptoms(LUTS)(20-30%)
• Symptoms of advanced disease

Question 10

What is the Work up of Bladder cancer?

Answer 10

-Urinalysis
-Cystoscopy
(Diagnostic standard w/ bx)
-CT scan w/ contrast, U/S and/or MRI

Question 11

What is the Tnm staging?

Answer 11

• T1 Tumor in wedge subepithelial connective tissue
• T2 Tumor in wedge muscle
• T3: through the muscle layer of the bladder and into surrounding adipose
• T4: spread beyond the adipose and into nearby organs or structures

Question 12

What is the Prognosis of bladder cancer?

Answer 12

• Overall 10 yr survival is 70%
• Lesions up to T1, especially TA, have 95% survival rate
• Muscle invasive carcinoma 5-year survival rates are 70%
• Regional lymph node involvement 5-year survival rate is 35% and distant mets 5%

Question 13

What is Treatment for bladder cancer?

Answer 13

-Muscle invasive versus non-muscle invasive treatment modalities
-Non-muscle invasive disease
-Surgery (Endoscopic TURBT, Radical cystectomy)
-Immunotherapy and chemotherapy
(Intravesicle instillation)

Question 14

What is Renal cell carcinoma?

Answer 14

• the proximal renal tubular epithelium

- 90-95% of all renal cancers

Question 15

What are the Signs and symptoms of Renal cell carcinoma?

Answer 15

• Hematuria (can be painless)
• CLASSIC TRIAD flank pain, hematuria, flank mass
• Frequent occurrence w/ paraneoplastic syndromes

Question 16

What’s the imaging of choice to diagnose renal cell carcinoma?

Answer 16

Abdomen/Pelvis CT w/ contrast