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Urology NTN Stations > Station 4 > Flashcards

Station 4 Flashcards

1
Q

NVH/ Negative Flexi/ USS 4 cm Upper Pole Renal Mass

Assess

A

History

Pain, Haematuria, Fevers, Lower Urinary Tract Symptoms
Red Flag Weight Loss, Change in appetite, Bone pain, SOB/DIB/Cough, Symptomatic anaemia

Risk Factors Smoking, Obesity, age, genetics, hypertension

FH - Urological Malignancy, Genetic Disorders

PMH/PSH
DH

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2
Q

Genenetic Disorders Associated with Renal Malignanc

A

Von Hippel Lindau
Hereditary papillary renal Carcinoma
Birt-Hogg-Dube

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3
Q

Examine

A

Consent

General - Cachectic/Anaemia
Abdomen - Palpable masses and lymph nodes (supraclavicular)
Lower Limb Oedema
Varicocele

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4
Q

investigate

A

Bloods -FBC, U&E, LFT, Calcium (Bone metastases)
Triple phase renal CT
CT Thorax

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5
Q

Features on CT Scan

A

Size + Location
Contrast Enhancement (15 HU Rise)
Extension (Extra-renal, renal vein, LN)
Surgical planning
evaluation of contralateral kidney

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6
Q

Indications for renal biopsy

A

i) Small tumour <3 cm
ii) Indeterminate mass radiologically - ?Lymphoma ?Secondary
iii) Considering active surveillance
iv) Considering ablative treatment
v) Considering systemic treatment in metastatic disease

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7
Q

Stage RCC

A

T0
T1 < 7 cm kidney limited to kidney
T2 >7 cm limited to kidney
T3 Limited by Gerota’s fascia
T3a - Perinephric tissue
T3b - IVC below diaphragm
T3C - IVC above diaphragm or ivc wall involvement
T4 - Beyond Gerota’s

N0
N1- Regional LN metastases (N1a = 1 node, N1b = More than one)

M0
M1 Distant metastases

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8
Q

Treatment options for localised RCC

A

Active Surveillance (?Biopsy first)
Focal Treatment - Cryotherapy / Radifrequency
Partial Nephrectomy
Radical Nephrectomy

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9
Q

Consent for nephrectomy

A

Bleeding, Infection, pain, shoulder tip pain, bloating, ileus
Hernia, Conversion to open

Damage - bowel, pancreas, spleen/liver, vessels
Benign pathology
dialysis requirement
anaesthetic risk

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10
Q

Examples of benign renal lesions

A

Cysts, Abscess, Angiomyololipoma, Oncocytoma

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11
Q

Bosniak Classification

A

1 - Inperceptible wall/no septae - 0% malignancy
2 - Thin few septae/calcification, no enhancement - 0% malignancy
2F - More septae, thicker or nodular septae, no enhancement - 5% malignancy
3- Thick nodular septae/ Clacification/ Some enhancement - 55% malignancy
4 - Solid, Cystic/necrotic components - 100%

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12
Q

Grading of renal Cancer

A

ISUP (1-4) - Has replaced fuhrmann
Leibovic Score ( Risk Stratification ) - Takes into account tumour characteristics. Grade, size, LN involvement, Necrosis etc.

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13
Q

RCC Subtypes:

A

Clear Cell (80-90%)
Chromophobe (2-5%)
Papillary (6-115%)

Benign:
AML, Oncocytoma

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14
Q

Indications for partial nephrectomy:

Absolute
Relative
Anything help stratify difficulty of partial nephrectomy?

Contraindications to PN:

A

Absolute
Bilateral Tumours
Contralateral abnormal kidney (single kidney/ single functioning kidney)

Relative
All T1 Disease
Other comorbidities risking nephrons

**PADUA Score - Indicates how difficult partial nephrectomy may be **

Contraindications
Insufficient volume of parenchyma to permit proper organ function
Renal Vein thrombosis
Tumour location (Vessel adherence)
Anticoagulants

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15
Q

benefits of partial nephrectomy cf total nephrectomy

A

Nephron Sparing
QOL
Comparable oncological outcomes other than for slightly increased rate of positive tumour margin

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16
Q

Likleihood of VH/NVH to predict malignancy

A

VH - 18.9%
NVH - 4.8%

17
Q

i) Phases of renal CT

ii) Other forms of renal mass imaging

A

i) Corticomedullary Phase - 30 seconds
Nephrographic Phase - 80-100 seconds
Urographic - 8-10 minutes

ii) MRI - Pregnant women, in people who can’t have contrast
Contrast enhanced ultrasonography - Useful for investigating cyst wall enhancement

iii) PET CT - May be useful in metastatic disease

iv) DMSA - useful in assessing split function

18
Q

WHen would you request renal biopsy?

A

?Competing primaries. ?Metastatic Disease
?Lymphoma
Bilateral Tumours
Prior to active surveillance
Prior to ablative treatment
Priot to systemic therapy

19
Q

When to perform adrenalectomy

A

Evidence of direct invasion on CT

Urology NTN Stations (12 decks)

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