Urological Malignancies

Question 1

Mention the imaging modality of choice for ccc renal masses, giving examples

Answer 1

CT urography (without then with contrast)
1. Malignant solid tumors +ve enhancement
2. Angiomyolipoma -ve
3. Simple cysts show clear content & thin wall, however complex cysts (sus for malignancy) may show enhancement, thick wall or multiple septae

Question 2

List tumors confused with Wilm’s tumor

Answer 2

Mesobkastic nephroma, clear cell sarcoma, rhabdoid tumor of kidney

Question 3

List investigations for Wilm’s tumor

Answer 3

CT, US for venous extenstion, MRI for vessel involvement, bone scan, chest X-ray for mets, abdominal X-ray for calcifications, percutaneous guided biopsy or open biopsy

Question 4

Describe ttt of Wilm’s tumor

Answer 4

Radical nephrectomy
Further ttt with chemo or radio depends on staging & histology. Non-favorable histologic ccc is anaplasia, hyperchromatism, mitosis, sarcomatous or rhabdoid degeneration

Question 5

The gold standard for screening for RCC is…..

Answer 5

Abdominal US

Question 6

Describe ttt of RCC in case of operable tumor

Answer 6

Radical nephrectomy is the gold standard open/laparoscopic, invaded tissues & vessels are also excised
In case of single kidney, bilateral tumors or less than 4 cm tumor, partial nephrectomy is done

Question 7

Describe ttt of RCC in case of inoperable tumor

Answer 7

Palliative nephrectomy, immunitherapy, antiangiogenesis agents

Question 8

The most common presentation of UB carcinoma is….

Answer 8

Painless intermittent hematuria

Question 9

Mention ttt of choice for each of the following:
1. Non-invasive TCC
2. Invasive TCC
3. SCC

Answer 9

1. TURBT (+BCG or local chemo)
   2 & 3 radical cystectomy and urinary diversion

Question 10

List methods of urinary diversion

Answer 10

Orthotopic diversion, intestinal conduit, ureterosigmoidostomy

Question 11

Invasive UB carcinoma is based on…..

Answer 11

Muscle invasion

Question 12

Describe the pathophysiology of symptom progression in BPH

Answer 12

1. Mild BOO leads to minimal symptoms
2. Inc w/ bladder compensation leads to obstructive LUTS
3. Inc w/ bladder instability leads to irritative LUTS
4. Hematuria is a common symptom due to congestion of bladder mucosa

Question 13

Compare results of DRE in BPH & prostatic carcinoma

Answer 13

B: soft, smooth, preservation of median sulcus, rectal mucosa is mobile
M: hard, asymetrical, no preservation of sulcus or notch, early mobile, late fixation

Question 14

Mention indications of biopsy in BPH

Answer 14

Elevated PSA or sus DRE

Question 15

Mention absolute & relative surgery indications in BPH

Answer 15

Abs, failure of medical ttt, severe symptoms, recurrent attacks of acute retention, significance backpressure on upper UT or uremia
Rel: hematuria, moderate symptoms, recurrent UTI, stone bladder

Question 16

How to prevent TURP $

Answer 16

Glycine for irrigation, control bleeding by amino-caproic acid

Question 17

Only curative option for locally advanced prostate cancer is….

Answer 17

Radical prostatectomy

Question 18

.

Question 19

MC presentation of testicular tumors is….

Answer 19

Painkess testicular swelling

Question 20

What is the role of of imaging in investigating testicular tumors?

Answer 20

US, CT & MRI are used for diagnosis not staging

Question 21

The radioresistant testicular tumor is…….

Answer 21

Non-seminomatous

Question 22

1ry management of all testicular tumors is…..

Answer 22

Radical inguinal orchidectomy through inguinal incision & cord incised at internal ring