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7 DD in renal tumor?
Polycystic kidney, hydronefrotic kidney, renal tuberculosis,
pyonephrosis, xantogranulomataus, pyelonephritis and solid
renal cyst. Cyst are the most common expansive process. US
are a good way to differentiate.
8 what are the symptoms of renal tumor except?
In the early stages, the kidney cancer presents no symptom. At
this stage, it is discovered incidentally at ultrasound
examination. The most common clinical manifestations are
urological and they are grouped in a triad represented by
hematuria, pain and kidney tumor
Hematuriais macroscopic, total, isolated or it accompanies
other clinical signs; it is difficult, unique or repeated, of low
intensity, or massive intensity with clots, which sometimes
determines the acute, complete retention of urine.
Flanktumor. The absence of the tumor cannot invalidate the
diagnosis of kidney cancer. When the tumor develops in the
upper pole of the kidney, the neo formation cannot be
palpated, unless it is larger. Like pain, the palpation of the
tumor is a sign of late diagnosis.
The palpation characters of the tumor are the lumbar contact
and baling. The tumor may be fix or mobile, which is very
important, because it shows a great tendency to local invasion
and even the impossibility of excision.
Rarely, the tumor ruptures spontaneously, especially when it
presents cystic areas or spread necrosis, making a syndrome
composed of brutal back pain, retroperitoneal hematoma,
signs of peritoneal irritation that associated with signs of
internal bleeding, leading to Wunderlich syndrome.
31mostfrequenttypeofhistologicaltypeofurotelialtumor?
Transitionalcellcarcinoma
32HOWDOSEUSLOOKINSIMPLERENALCYST?
Black/darkgray,hypoechoic,singlewelldefinedcysticlesion,thinnwalls,
acousticenhancementposterior
33renaltumorsclinicaltypes?(differentkinds)
Hematuriaform
Tumorform
Febrileform(prolongedhyperpyrexia,itisnotinfluencedbyantipyretics
andantibiotics,itosduetosomepyrogenicproteinsresultingfrom
tumoralnecrosis)
Theformwithpolyglobulia
TheHTNform(duetotheexistenceofanarterialvenousfistulainthe
tumororitmayoccursecondarytoatumorthatdevelopsintherenal
hilum.Thevascularcompressionmayleadtorenalischemia)
Hypercalcemiasyndromeforms(neuromuscular,gastrointestinaland
cardiovasculardisorders)
Silentforms(withhematuria,albuminuria,hypertension)
Metastaticforms(10%,thefirstsignofthediseaseiscausedby
metastasis)
Otherforms:withhepaticdysfunction(Stauffersyndrome),Cushings
syndrome,Sanarellisyndrome(calciumdeposits)
34whatistrueaboutclearcellcarcinoma?
8090%ofallrenalcellcarcinomasareclearcellcarcinomas,moreinfoon
page148
35whatisfalseaboutPSA?
Prostatespecificantigenisaglycoproteinsecretedbyprastate,whichprevents
spermclotting.PSAmaybedeterminedfromserumbyradioorimmunoassay
methods,withelevatedvaluesbothinHBPandinPC.Butappearanceofthe
PCtissueincreasesserumvaluesofPSA10timesmorethenthesamequanity
ofBPHtissue.However,20%ofthePCfoundareaccompaniedbynormal
levelsofPSA.Generally,themaximumnormalvalueofPSAis3,2ng/ml.
PSAisanextremelyusefulvalueforincipientandearlyprastatecancer
diagnosis.PSAhasaspecialvalueinthecontrolandmonitoringtherapy.We
mayconcludthatPSAisausefulmarkerforposttherapyscreeningand
tracking.PSAisanorganicspecifikmarker.Afteratotalprostatectomy,it
becomesatumorspecifikmarker,veryusefulinmonitoringtheevolutionof
surgery.BasedonserumPSAvalues,theeffectofradiotherapyorhormone
therapyismonitored.
36ProstatetumorT3cH3M1bhowisthetreatmentofthis?(T3c
H2M1bisatypeofclassification)
palliativetreatmentforpatientsw/boneMT(M1bMetastasesinBones):
Radiotherapy,admin.STRONTIUM89(p.146)
37whatabout5alphareductasisfalse?
MinimalAndrogenBlockade(treatmentoflocallyadvancedPCwithor
withoutMTT3,T4,N1,M1):combiofminimumnonsteroidantiandrogen5
alphareductaseinhibitor(FINASTERIDE).Testosteronelevelswillbelow,no
significanteffectonsexualfunction
enzymeresponsibleforthetransformationoftestosteroneinDHT,levelsof
thatenzymeincreasewithage(DHTbeinginvolvedinetiologyofBPH)
38fullerfreyeroperation
OpensurgeryforBPH,impliesdigitalcutofnucleusofadenoma
(adenomectomy)throughSUPRAPUBICtransbladderapproach.Notvery
commonanymore,onlyusedwhenademoais>60g.
(Millintechniqueretropubic)
39thetechnicsinsurgicaltreatmentofkidneystones?
PCNLanystone,nonregardingitslocation,size,hardness,volume,number
Ureteroscopyalsosolvebenignstenosesofproximalureter
Laparoscopyforpylo,ureteralandrenalcalculi
ESWLinsuperiorurinarysystem>1,5cmindiameter
Nephrectomy,Pylolithotomy,Pylonephrolithotomy,anatrophic
Nephrolithotomy,radialPolinephrotomy,Benchprocedurenotused
anymoreEXECPTURETEROLITHOTMYwhenESWL,PCLN,URSA,
URSRfail.
40whatistrueinactivesurgicalliteasis(theoneuneedtooperate)?
surgicaltreatmentisindicatedforallstoneswhichcannotbeeliminated
spontaneoisly.MostlybyESWL.Usedinstonesinthesuperiorurinarytract
associatedwithUTIinwhichothertreatmentfails.progessiverenal
parenchymalpain,obstructionofurinarychannelandpersistentpain(page109)
41 the pain in the renal colic? (what is it and why)
very intense, paroxistic (sudden) pain. Any obstacle that suddenly appears on the superior
urinary channel (clot, calculus, pus, external obstacles) can start the renal colic. From a
physiopathological point of view, the renal colic is the result of a hyper-pressure appeared
at the level of the superior urinary channels. Muscular spasm and the distension of the renal
capsule, which accompany it, contribute to the amplification of the pain.
frequently?
The most common stone is calcium oxalate, also men have bigger risks, and it runs in family.
(secondary hyperurecemia du to purines from food/alchool is also more common type)
Not drinking enough water. When you don't drink enough water, the salts, minerals, and other
substances in the urine can stick together and form a stone. This is the most common cause
of kidney stones.
Medical conditions. Many medical conditions can affect the normal balance and cause stones to
form. Examples include gout and inflammatory bowel disease, such as Crohn's disease. HPT, Vit d
excess, immobilization etc
44 renal contusion?
Cloused trauma = contusions
More in Men and adults. Right is more vulnerable due to its
lower position.
The blood filled kidney causes an hydrostatic pressure and has
friable tissue also contributing to contusions.
2 groups of contusion
Direct - for example in car accident
Indirect ex falling from great hight causing lesions of renal
pedicle. Body stops when hit ground the heavy kidney (blood
filled) continues to fall rupturing the pedicle. Usually
associated with pollytrauma.
lesions can occur at 2 components of the kidney
1 Parenchymal lesions (hemorrhagic and ischemic)
1) Subcapsular hematoma = Renal capsul is intact after minimal superficial fissure,
single or multiple, or when deep lesions are produced, interested in parenchyma, associated
with or without calyx and renal pelvis lesions, hemorrhage followed by an accumulation of
subcapsular blood, making subcapsular hematoma witch may or may not be associated
with hematuria deepending on if there are lesions on the excretory pathways.
2) Perirenal hematoma = When renal capsule is affected, blood flows perirenal.
If severe parenchymal injury with severe injury to the capsule can result in
Renal rupture
Crushing and Kidney explosion depends on trauma that occurred
2. Pedicle lesions
The pelvis is detached, Also arteris or/and veins can be teared causing massive
retroperitoneal hemorrhage, wich can lead to hemorrhagic shock and death.
When less severe, when there is partial fractures it can cause vessel thrombosis, or scar
stenosis, with post traumatic hypertension. Hematuria does not accompany the isolated
lesion of the renal pedicle.
3. Intrarenal excretory pathway lesions (calyx, basin)
Not isolated lesion, The Urine goes into the retroperitoneal space, its associated with
fissure or parenchymal rupture, with hematuria leading to AUR by clots (inferior Urinary
trackt)
4.Associated lesions
Parietal ruptures are more common, fractured ribs (11,12) lesion of abdominal organs. At
the perineal fat it can form a perineal hematoma.
Clinical manifestations
Patient history (what happened)
General signs: vary depending on severity
Local signs: pain, hemorrhage, perirenal hematoma (blood to kidney fat), Internal
hemorrhage (into peritoneal cavity), hematuria, hematuria can be absent if
ureter is
therapeutic attitude tracking. Also it informs about the state of other abdominal
parenchymal organs (liver, spleen, pancreas). Instead it does not provide a large range
of information or the accuracy of the CT and arteriography of the renal pedicle.
Doppler ultrasound increases the accuracy of the ultrasound about the damage of the
renal pedicle.
EVOLUTION
In most of the cases, the evolution is favorable with spontaneous disappearance of
hematuria, the return to normal of the heart rate, arterial tension (AT) and the
stabilization limits of lumbar hematoma. Sometimes the evolution is severe, bleeding
continues and lumbar hematoma increases in size, requiring emergency surgery for the
purpose of hemostasis (renal suture, partial nephrectomy or nephrectomy). Sometimes, in
a variable interval, between 8 days and 2 months, when everything seemed to come into
normal, signs of a major internal bleeding appear, with signs of hemorrhagic shock with or
without abundant hematuria, by kidney rupture. Emergency surgery is required.
COMPLICATIONS
Bleeding occurs as a perirenal hematoma with a two-stage evolution, or as a total
hematuria.
Early infection of the urinary tract. Late complications are: posttraumatic hydronephrosis,
after a interstitial hematoma is formed, with progressive dilatation and renal parenchymal
destruction. Urohematic cyst, posttraumatic hydronephrosis and arterial hypertension of
posttraumatic renal origin that is caused by renal vascular lesions, such as
arteriovenousaneurysm.
DIAGNOSIS
Renal contusion diagnosis relies on case history (information on the circumstances of
the accident) and on the cardinal symptoms (hematuria and pain). In addition, the
lesions associated with other viscera must be specified (abdominal or thoracic), which
almost always coexist. To specify the type of renal injury and to determine the
prognosis and therapeutic attitude in conditions of renal contusions, described
radiological explorations and ultrasound are indicated. From the beginning it should be
noted that at 3-6 months after trauma, an ultrasound and an urography examination
will be performed to assess the progress of the perirenal scar and / or retroperitoneal,
with secondary effects on urinary paths and on renal pedicle.
TREATMENT
Statistics show that 80% of the renal contusions receive a conservative
treatment consisting of:
compulsory bed rest;
shock removal when necessary;
monitoring of vital functions and of the development of renal trauma;
pain relievers;
preventive antibiotics;
Perfusions for balancing volume and electrolyte and for diuretic effect.
When with all the above measures the hematuria persists and / or perirenal
hematoma increases and it is associated with signs of anemia and the general condition
declines, the question of surgery appears, which should be conservative. Nephrectomy is
required only in cases of irreversible kidney damage, or where vital necessity requires. The
access path is represented by a lobotomy or a laparotomy which allows the treatment of any
associated abdominal injuries.
Surgery consists of:
evacuation of retroperitoneal urohematoma;
simple fissure, unique, is sutured with wires in X, polar localized lesions can be
followed by partial nephrectomy. Large lesions, explosive, pediculare lesions, that are not
easily rebuilt require nephrectomy;
ensuring a safe hemostasis;
effective lumbar drainage
The patient will be followed from 6 months to assess the degree of functional recovery and
the occurrence of late complications, which may require secondary surgical therapy.
(retrograde
ureteropyelography)
extracorporeal
lithotripsy
(ESWL),
or
percutaneous
extraction
51 hypospadias ?
The Hypospadias is an anomaly of the urethra opening from the
ventral side of the penis. Usually this is small and curved down.
The anomaly is the consequence of a development interruption
that leads to an incomplete welding of genital fold or to an
incomplete growth of genital buds. According to the location of
the ectopic urethral meatus, several anatomic forms of
hyspodias can be distinguished: balanic, penian, penoscrotal,
perineoscrotal hypospadias (vulviform). The sponge body stops
developing and with him, the urethra stops too and it is
replaced by a tissue blade that keeps the penis curved. Urethral
plasty techniques use skin flaps from the penis or scrotum.