6. Renal neoplasms and disorders of the adrenal gland; Benign prostatic hyperplasia Flashcards Preview

Urology > 6. Renal neoplasms and disorders of the adrenal gland; Benign prostatic hyperplasia > Flashcards

Flashcards in 6. Renal neoplasms and disorders of the adrenal gland; Benign prostatic hyperplasia Deck (16)
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1
Q

Renal cell carcinoma (RCC)

A

Most common malignant tumor of the kidney. It is an adenocarcinoma arising from
tubular epithelium. It has a tendency to grow into the renal vein and IVC.

2
Q

Renal cell carcinoma risk factors

A
• Smoking
• Obesity
• Asbestos
• Phenacetin (analgesic)
• Von Hippel Lindau syndrome (autosomal dominant inactivated VHL tumor
suppressor gene on chromosome 3)
3
Q

Renal cell carcinoma symptoms

A
• Hematuria
• Palpable abdominal mass
• Flank pain
• Paraneoplastic symptoms: 
 - HTN, 
 - weight loss, 
 - anemia, 
 - polycythemia
4
Q

Robson staging for Renal cell carcinoma

A
  • Stage 1: Tumor within renal capsule (80% 5 year survival)
  • Stage 2: Outside capsule, within Gerota’s fascia surrounding the perinephric fat (60%)
  • Stage 3: Involvement of regional lymph nodes, renal vein, or IVC (20%)
  • Stage 4: Adjacent organs or distant metastasis (10%)
5
Q

Diagnosing RCC

A

Start with an US that can show a cyst with an intracystic element or calcified wall.

Follow up with contrast enhanced CT.
The mass will enhance with the contrast and renal vein involvement can be shown.

CT scan of the chest can demonstrate potential metastasis. Bones are major site, also abdom inal or thoracic.

6
Q

RCC treatment

A

RCC does NOT respond to chemotherapy or radiation.

Partial nephrectomy if the tumor is <4cm and isolated to within the renal fascia.

For all others, radical nephrectomy, including perinephric fat, lymph nodes, and adrenal glands.

Renal artery embolization can be done as palliative care.

VHL patients should probably have both kidneys removed and kidney transplant.

Immunotherapy with anti-VEGF agents, as well as IL-2 or INF-alpha treatment are palliative for metastatic disease. .

7
Q

List the renal neoplasms

A

Renal cell carcinoma

Angiomyolipoma

Oncocytoma

Wilms tumor

Transitional cell carcinoma of the pelvis/ureter.

8
Q

Angiomyolipoma

A

A hamartoma: Benign overgrowth of well-differentiated cells, often with one element predominating.

Frequently bilateral.

Often associated with Tuberous sclerosis (AD syndrome with mental retardation and epilepsy).

Can cause gross hematuria and internal hemorrhage. If it is larger than >4cm it should be removed due to risk of bleeding.

9
Q

Oncocytoma

A

1/3 of cases occur together with RCC. Arise from collecting ducts. Cannot be distinguished radiographically from RCC. Should be removed.

Epithelial cells from the collecting ducts characterized by an excessive number of mitochondria, resulting in an abundant acidophilic, granular cytoplasm

10
Q

Wilms tumor

A

Most common urinary tract malignancy in childhood. Median age is 3 years old.

20% familial, 5% are bilateral.

Arise from abnormal proliferation of remnants of immature kidney (metanephric blastema).

Presents as a palpable abdominal mass.

Prognosis is 55-95%, depending on stage and histological subtypes.

Treatment: Radical nephrectomy with or without chemotherapy (actinomycin, vincristine or doxorubicin)

11
Q

Transitional cell carcinoma (TCC) of the renal pelvis and ureter

A

Arise from transitional cells of renal pelvis. Presents as painless gross hematuria.

Urine cytology will show malignant cells.

Diagnosis is made with IV urography and CT scan.

Treatment: Nephro-ureterectomy with chemotherapy.

NB: Reoccurrence in the bladder in 50% of cases and contralateral kidney in 2%.

12
Q

List the disorders of the adrenal glands (8)

A

Cushing´s syndrome - any cortisol hypersecretion or administration

Cushing’s Disease - Pituitary ACTH adenoma

Conn’s syndrome - Hyperaldosteronism

Adrenal cysts

Adrenal carcinoma

Pheochromocytoma

Ganglioneuroma

Neuroblastoma

13
Q

Benign prostatic hyperplasia

A

Most common urological disease

Causes bladder outlet obstruction and increasingly difficult urination.

Mainly hyperplasia in the transitional zone

14
Q

What causes obstruction in BPH

A

• Mechanical obstruction: The direct effect of the enlargement of the gland.

• Dynamic obstruction: Smooth muscle fibers within the prostate are richly innervated by adrenergic fibers of the sympathetic nervous system.
Giving alpha1-blockers (tamsulosin or doxazosin) are used to decrease sympathetic stimuli and relax the smooth muscles.

• Detrusor response: As the outlet resistance increase, the bladder responds by
increasing its force of contraction, to try to maintain flow.
This will eventually cause detrusor muscle hypertrophy and hyperplasia, and collagen deposition
–> severe bladder decompensation and dilation –>
ureterovesicle obstruction –> hydronephrosis –> renal insufficiency.

15
Q

Symptoms of BPH

A
• Obstructive symptoms:
 Decreased urinary flow
 Staccato flow
 Difficult to start
 Residual volume in bladder
 Feeling of incomplete evacuation
• Irritative symptoms:
 Nocturia
 Pollacisuria (increased frequency)
 Urgency
 Alguria (painful urination)
16
Q

BPH treatment

A

• Alpha1-blockers: Inhibits the sympathetic input to the prostatic muscle fibers.

Averse effects: Hypotension, retrograde ejaculation, tiredness, dizziness and erectile dysfunction.
o Tamsulosin
o Doxazosin, Prazosin

• 5-alpha-reductase inhibitors: Reduce prostate volume within 6 months. Finasteride, Dutasteride.
Recommended in > 40g prostate. Same side effects as alpha1-blockers.
Combination therapy is the most effective.

• Transurethral resection of prostate: TURP. A rectoscope is used with an electrically charged wire know as a “hot loop”. The outer prostate gland is left in the surgical capsule (thickened psudocapsule as a result of the compression)

o TURP syndrome: A life-threatening complication. Can occur if the operation last longer than 1 hour. Caused by high-pressure water irrigation resulting in hypervolemic hyponatremia.

Can cause osmotic swelling and bursting of RBCs and swelling of brain cells leading to coma and death.

If this occurs might have to place the patient on hemodialysis.