Tumor Saluran Kemih (Tumors/Malignancy of Urinary Tract)

Dr.M.Galuh Richata, SpU

Tumors of the Urinary Tract

Kidney Ureter Bladder Prostate Urethra (very rare) External Genital (penis & testicular)

Kidney Tumors
Tumor from the Parenchyma: - Renal Cell Carcinoma (most kidney tumor in adults) - Nephroblastoma / Wilms Tumor (in children) Tumor of the Epithelium: Urothelium Tumor of the Renal Pelvis (= Urothelium Tumor of Urinary Tract)

Kidney Tumors
Presentation: Triad of classic signs & symptoms - Palpable mass (40%) - Flank pain (40%) - Hematuria (60%) all exist only 10-15%

Kidney Tumors
Presentation Sign/symptoms secondary to metastases: Lung dyspnea, cough Brain seizure, headache Bone bone pain

Kidney Tumors
Presentation Paraneoplastic Syndrome: - Erythrocytosis - Hypercalcemia - Hypertension - Nonmetastatic hepatic dysfunction

Kidney Tumors
Imaging USG, IVP/IVU, CT Scan, MRI Intervention Mostly surgical, depends on the staging (TNM) Prognosis: poor 5 year survival rate : 50% (overall) 70% if no metastases 15-20%, if renal vein involved

Tumors of Urothelium
From the urothelial lining of the urinary tract ( the transitional cells) transitional tumor / transitional cell carcinoma May arise anywhere in the urinary tract, but predominantly in bladder (then in renal pelvis/calices >> ureter >> urethra)

Bladder Cancer
Transitional Cell Carcinoma (TCC) of the bladder Squamous Cell Carcinoma (Epidermoid) of the bladder Adenocarcinoma of the bladder Rhabdomyosarcoma of the bladder Etc

Transitional Cell Carcinoma

Peak incidence: 50 70 years old Men : women = 3 : 1 Risk factor:
Smoking Chemical exposure: Aromatic hydrocarbons Chronic irritation/inflammation: stone, worm, infection Radiation exposure

Transitional Cell Carcinoma

Sign & Symptoms Hematuria : about 80% gross hematuria Classic symptom: recurrent-painless hematuria. Dysuria and irritative symptoms (30%) Upper urinary tract obstruction (advanced disease)

Transitional Cell Carcinoma

Diagnosis Imaging : USG, IVU, CT scan, MRI

Urine cytology

Transitional Cell Carcinoma

Cystoscopy

Transitional Cell Carcinoma

Clinical Stage

Transitional Cell Carcinoma

Intervention Surgery (Endoscopic, Cystectomy) Chemotherapy Radiation

Tumors of Urinary Tract

Every patients with hematuria must be suspected as a patient with malignancy, until it is proven otherwise

Genetic and Congenital Disease of Urinary Tract

Disorders of the: - Kidney - Ureter - Bladder - Urethra & Genitalia

Disorders of the Kidney

Agenesis (mostly unilateral; bilateral very rare) Hypoplasia Supernumerary Simple Cyst Multicystic Kidney Polycystic Kidney Disease

Disorders of the Kidney

Renal Fusion (horse shoe kidney) Ectopic Kidney Abnormal Rotation

Disorders of the Ureter

PUJO (PelvioUreteral Junction Obstruction) VesicoUreteral Reflux Ectopic Ureteral Orificium Double Collecting System Ureterocele

Disorders of the Bladders

Extrophy Bladder Persistent Urachus Contracture of the Bladder Neck

Disorders of Urethra & Genitalia

Urethral Stricture Posterior Urethral Valve Hypospadia Epispadia Priapism Phimosis Paraphimosis