Surgery Uro Flashcards
t/f adrenal gland incidentalomas are found by chance
true
t/f adrenal adenomas and incidentalomas are larger than adrenal cancers
false, cancers are larger.
larger than 5 cm = cancer
management for adrenal cancer
- open adrenalectomy: incision almost half the abdomen
- laparoscopic adrenalectomy: keyhole incisions
most common type of pediatric renal cancer
wilm’s tumor or nephroblastoma
management for pediatric renal ca
transverse laparotomy, nephrectomy
most common type of kidney ca in adults
renal cell ca
triad of renal cell ca
flank pain, renal mass, hematuria
staging of renal cell ca
1: originates and is in renal parenchyma, <7 cm
2: >7 cm
3: tumor extended within kidney (parenchyma, blood vessels, ln)
4: tumor extended beyond kidney
management of renal cell ca
- partial nephrectomy =4 cm
- radical nephrectomy (kidney, fatty tissues, ureter) +/- adrenal gland +/- ln resection
squaca of the kidney associated with long standing nephrolithiasis (staghorn calculus)
renal squamous cell ca
chronic irritation, inflammation, infection -> squamous metaplasia
in transitional cell ca of renal pelvis and collecting system, tumor starts in ___
ureter and/or calyces of renal pelvis
management of transitional cell ca
- radical nephroureterectomy with bladder cuff excision
- must remove all continuous transitional cell lining
- minoter with cytoscopy
t/f ureteral ca is common
false
diagnostics for ureter malignancy
- initial: ct scan (urogram, iv urogram, stonogram)
- retrograde pyelography for confirmation
- ureteroscopy
- biopsy
management of ureter malignancy
- ensure that there is no renal pelvis tumor (antegrade seeding or extension)
- check for bladder ca (retrograde extension)
- no other pathologies = excise/ resect affected segment
if ureter tumor is too short, ___ can be done
ureteroneocystostomy
- psoas hitch
- boari flap
transuretero-ureterostomy
types of bladder ca
- transitional cell ca !!!
- adenoca
- squaca of the bladder
diagnosis of bladder ca
- cystoscopy for identification
- transurethral resection of bladder tumor + biopsy
staging for bladder ca
1 no deep muscle involvement
2 muscle involvement
3 through muscle wall, fatty layer of tissue around bladder, or prostate, regional ln
4 spread into pelvic wall, abdominal wall, ln outside pelvis, other parts of body
management for transitional cell ca
1 turbt + adjuvant intravesical chemo (bgc, mitomycin, thiotepa)
2, 3, 4 radical cystectomy
- men: + prostate and seminal vesicles
- women: uterus, ovaries, and part of vagina
most common method to create a new bladder
radical cystectomy with ileal conduit
what happens in radical cystectomy with ileal conduit
- ureters are attached to proximal ileal conduit
- distal end will become urostomy (incintinent urinery diversion)
what happens in radical cystectomy with continent urinary diversion
- cut out distal ileum until ascending colon
- ascending colon = new bladder
- ileum is sown to anterior abdominal wall
- patient has to put catheter through ileum to pee
what happens in radical cystectomy without urinary diversion
- bladder is reconstructed form colon and anastomosed to urethra
- ureters attach to new bladder
- intermittent catheterization needed (every 4-6 h)
for stage 2-4 transitional cell ca, ____; for adenoca for the bladder ___
tcc = radical cystectomy required
adenoca = partial ca as long as there is adequate bladder left (must verify by turbt)
what happens in partial cystectomy
- remove part of bladder +/- ln dissection
- can be with urachal remnant
diagnostic tests for prostate ca
- prostate specific antigen
- digital rectal examination
- prostate biopsy
- mri-us fusion prostate biopsy
pr-rads classification
I most probably benign II probably benign III intermediate IV probably malignant V most probably malignant
management for prostate ca
surgery: radiacl prostatectomy
radio: ebrt (igrt and imrt), brachy
hormonal: androgen deprivation therapy, complete androgen blockade
types of prostatectomy
- radical: + seminal vesicles and ln
- open surgical: via abdomen or perineum
- laparoscopic: via keyhold incisions
- robot assisted laparoscopic
types of radiotherapy for prostate ca
- external beam radiation therapy (intensity modulated radiation therapy or image guided radiation therapy)
- internal radiotherapy (brachy): high dose brachy (needles) or low dose (seeds)
types of hormonal therapy for prostate ca
- medical castration: androgen deprivation therapy
- lhrh agonist induces t production -> negative feedback -> decreases t (leuprolide, goserelin, triptorelin)
- lhrh antagonist blocks lh (degarelix)
- complete androgen blockage blocks the effects of testosterone in end organ (bicalutamide and flutamide)
- orchiectomy
t/f testosterone feeds the growth of prostate ca
true, drugs that block the action of t can treat men with advanced prostate ca
most common type of penile ca
squaca or epidermoid ca
others: basal cell ca, melanoma, sarcoma
risk factors for penile ca
hpv, uncircumcised, phimosis, smegma
management for penile ca
- partial penectomy if small
- total penectomy if big
- lymphadenectomy improves survival
more than 90% of testicular cancer are ___
main types of germ cell tumors ___
90% are germ cells
main types: seminomas and non-seminomas (embryonal ca, yolk sac, chorioca, teratoma)
general rule for testicular ca
extra testicular (epididymis, vas deferens, spermatic cord) = benign
intra vesicular (testes) = malignant
serum markers for testicular ca
afp, ldh, hcg
staging of testicular ca
read
surgical management for testicular ca
- radical inguinal orchiectomy (inguinal incision, testicle + spermatic cord)
- simple orchiectomy (scrotal incision)
radiotherapy for testicular ca
- seminomatous: radical orchiectomy + adjuvant radiotherapy
- does not work for non-seminomatous
treatment for nonseminomatous testicular ca
radical orchiectomy and/or chemo and/or radio and/or retroperitoneal ln dissection (until aorta and vena cava)
