Dr.M.

Galuh Richata, SpU

 Kidney 
 Ureter
 Bladder 
 Prostate
 Urethra (very rare)
 External Genital (penis & testicular)
 Tumor from the Parenchyma:
- Renal Cell Carcinoma (most kidney tumor in
adults)
- Nephroblastoma / Wilm’s Tumor (in
children)
 Tumor of the Epithelium:
Urothelium Tumor of the Renal Pelvis (=
Urothelium Tumor of Urinary Tract)
 Presentation:
“Triad of classic signs & symptoms”
- Palpable mass (40%)
- Flank pain (40%)
- Hematuria (60%)
 all exist only 10-15%
 Presentation
Sign/symptoms secondary to metastases:
Lung  dyspnea, cough
Brain  seizure, headache
Bone  bone pain
 Presentation
“Paraneoplastic Syndrome”:
- Erythrocytosis
- Hypercalcemia
- Hypertension
- Nonmetastatic hepatic dysfunction
 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
 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)
 Transitional Cell Carcinoma (TCC) of the
bladder
 Squamous Cell Carcinoma (Epidermoid) of
the bladder
 Adenocarcinoma of the bladder
 Rhabdomyosarcoma of the bladder
 Etc…
 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
Sign & Symptoms
 Hematuria : about 80% gross hematuria
Classic symptom: recurrent-painless
hematuria.
 Dysuria and irritative symptoms (30%)
 Upper urinary tract obstruction (advanced
disease)
Diagnosis
 Imaging : USG, IVU, CT scan, MRI

 Urine cytology
 Cystoscopy
Clinical Stage
Intervention
 Surgery (Endoscopic, Cystectomy)
 Chemotherapy
 Radiation
Every patients with
hematuria must be
suspected as a patient
with malignancy,
until it is proven
otherwise
Disorders of the:
- Kidney
- Ureter
- Bladder
- Urethra & Genitalia
 Agenesis (mostly unilateral; bilateral  very rare)
 Hypoplasia
 Supernumerary
 Simple Cyst
 Multicystic Kidney
 Polycystic Kidney Disease
 Renal Fusion (horse shoe kidney)
 Ectopic Kidney
 Abnormal Rotation
 PUJO (PelvioUreteral Junction Obstruction)
 VesicoUreteral Reflux
 Ectopic Ureteral Orificium
 Double Collecting System
 Ureterocele
 Extrophy Bladder
 Persistent Urachus
 Contracture of the Bladder Neck
 Urethral Stricture
 Posterior Urethral Valve
 Hypospadia
 Epispadia
 Priapism
 Phimosis
 Paraphimosis