Surgery Uro

Question 1

t/f adrenal gland incidentalomas are found by chance

Answer 1

true

Question 2

t/f adrenal adenomas and incidentalomas are larger than adrenal cancers

Answer 2

false, cancers are larger.

larger than 5 cm = cancer

Question 3

management for adrenal cancer

Answer 3

• open adrenalectomy: incision almost half the abdomen

- laparoscopic adrenalectomy: keyhole incisions

Question 4

most common type of pediatric renal cancer

Answer 4

wilm’s tumor or nephroblastoma

Question 5

management for pediatric renal ca

Answer 5

transverse laparotomy, nephrectomy

Question 6

most common type of kidney ca in adults

Answer 6

renal cell ca

Question 7

triad of renal cell ca

Answer 7

flank pain, renal mass, hematuria

Question 8

staging of renal cell ca

Answer 8

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

Question 9

management of renal cell ca

Answer 9

• partial nephrectomy =4 cm

- radical nephrectomy (kidney, fatty tissues, ureter) +/- adrenal gland +/- ln resection

Question 10

squaca of the kidney associated with long standing nephrolithiasis (staghorn calculus)

Answer 10

renal squamous cell ca

chronic irritation, inflammation, infection -> squamous metaplasia

Question 11

in transitional cell ca of renal pelvis and collecting system, tumor starts in ___

Answer 11

ureter and/or calyces of renal pelvis

Question 12

management of transitional cell ca

Answer 12

• radical nephroureterectomy with bladder cuff excision
• must remove all continuous transitional cell lining
• minoter with cytoscopy

Question 13

t/f ureteral ca is common

Answer 13

false

Question 14

diagnostics for ureter malignancy

Answer 14

• initial: ct scan (urogram, iv urogram, stonogram)
• retrograde pyelography for confirmation
• ureteroscopy
• biopsy

Question 15

management of ureter malignancy

Answer 15

• 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

Question 16

if ureter tumor is too short, ___ can be done

Answer 16

ureteroneocystostomy

• psoas hitch
• boari flap

transuretero-ureterostomy

Question 17

types of bladder ca

Answer 17

• transitional cell ca !!!
• adenoca
• squaca of the bladder

Question 18

diagnosis of bladder ca

Answer 18

• cystoscopy for identification

- transurethral resection of bladder tumor + biopsy

Question 19

staging for bladder ca

Answer 19

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

Question 20

management for transitional cell ca

Answer 20

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

Question 21

most common method to create a new bladder

Answer 21

radical cystectomy with ileal conduit

Question 22

what happens in radical cystectomy with ileal conduit

Answer 22

• ureters are attached to proximal ileal conduit

- distal end will become urostomy (incintinent urinery diversion)

Question 23

what happens in radical cystectomy with continent urinary diversion

Answer 23

• 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

Question 24

what happens in radical cystectomy without urinary diversion

Answer 24

• bladder is reconstructed form colon and anastomosed to urethra
• ureters attach to new bladder
• intermittent catheterization needed (every 4-6 h)

Question 25

for stage 2-4 transitional cell ca, ____; for adenoca for the bladder ___

Answer 25

tcc = radical cystectomy required adenoca = partial ca as long as there is adequate bladder left (must verify by turbt)

Question 26

what happens in partial cystectomy

Answer 26

- remove part of bladder +/- ln dissection | - can be with urachal remnant

Question 27

diagnostic tests for prostate ca

Answer 27

- prostate specific antigen - digital rectal examination - prostate biopsy - mri-us fusion prostate biopsy

Question 28

pr-rads classification

Answer 28

``` I most probably benign II probably benign III intermediate IV probably malignant V most probably malignant ```

Question 29

management for prostate ca

Answer 29

surgery: radiacl prostatectomy radio: ebrt (igrt and imrt), brachy hormonal: androgen deprivation therapy, complete androgen blockade

Question 30

types of prostatectomy

Answer 30

- radical: + seminal vesicles and ln - open surgical: via abdomen or perineum - laparoscopic: via keyhold incisions - robot assisted laparoscopic

Question 31

types of radiotherapy for prostate ca

Answer 31

- external beam radiation therapy (intensity modulated radiation therapy or image guided radiation therapy) - internal radiotherapy (brachy): high dose brachy (needles) or low dose (seeds)

Question 32

types of hormonal therapy for prostate ca

Answer 32

- 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

Question 33

t/f testosterone feeds the growth of prostate ca

Answer 33

true, drugs that block the action of t can treat men with advanced prostate ca

Question 34

most common type of penile ca

Answer 34

squaca or epidermoid ca others: basal cell ca, melanoma, sarcoma

Question 35

risk factors for penile ca

Answer 35

hpv, uncircumcised, phimosis, smegma

Question 36

management for penile ca

Answer 36

- partial penectomy if small - total penectomy if big - lymphadenectomy improves survival

Question 37

more than 90% of testicular cancer are ___ main types of germ cell tumors ___

Answer 37

90% are germ cells main types: seminomas and non-seminomas (embryonal ca, yolk sac, chorioca, teratoma)

Question 38

general rule for testicular ca

Answer 38

extra testicular (epididymis, vas deferens, spermatic cord) = benign intra vesicular (testes) = malignant

Question 39

serum markers for testicular ca

Answer 39

afp, ldh, hcg

Question 40

staging of testicular ca

Answer 40

read

Question 41

surgical management for testicular ca

Answer 41

- radical inguinal orchiectomy (inguinal incision, testicle + spermatic cord) - simple orchiectomy (scrotal incision)

Question 42

radiotherapy for testicular ca

Answer 42

- seminomatous: radical orchiectomy + adjuvant radiotherapy | - does not work for non-seminomatous

Question 43

treatment for nonseminomatous testicular ca

Answer 43

radical orchiectomy and/or chemo and/or radio and/or retroperitoneal ln dissection (until aorta and vena cava)