working with organic chemicals and dyes
abuse of pain-control medications especially phenacetin
exposure to arsenic and aromatic amines
schistosomiasis
B. abuse of pain-control medications especially phenacetin
continue the procedure as perforations at this site do no harm
abort the procedure and leave a urethral catheter
convert tumor removal to open method and repair the defect
perform abdominal exploration and manage accordingly
30%
40%
50%
60%
the lesion is solitary and no associated CIS
physically, a surgical margin of 2-cm can be obtained
the resected area should be far enough from ureteral orifices and the bladder neck
all of the following
en bloc resection involving total penectomy, cystoprostatectomy, resection of the pubic rami and urogenital diaphragm, with pelvic lymphadenectomy. In addition, creating a urinary diversion.
total penectomy involving removal of the penis, urethra, and penile root
partial penectomy involving excision of the malignant lesion with 2-cm margins
transurethral resection or fulguration
leiomyoma
hemangioma
fibroepithelial polyp
lymphangioma
mid prostate to the verumontanum at the 5 and 7 oclock positions
lateral margins of the prostate at the 10 and 2 oclock positions
entire area distal to the urethral crest
area between ejaculatory duct openings and prostatic utricle
frequently found in association with high-grade or extensive TCC
has a rate of progression to muscle invasion of 10-25%
significant areas of CIS are easily missed by routine cystoscopy
treatment begins with TURBT
ascending urethrography
voiding cystourethrography
MRI
IVU
undergo cystectomy
try mitomycin c
take a second course of BCG
take a second course of BCG + quinolones
upper ureter
middle ureter
lower ureter
comparable
adenocarcinoma
transitional cell carcinoma
squamous cell carcinoma
basal cell carcinoma
radical cysto-prostatectomy
anterior pelvic exenteration
bilateral pelvic lymphadenectomy
creation of a urinary diversion
tumor stage
tumor grade
lymphovascular invasion
lymph node spread
well-differentiated tumor with broad-based invasive font
marked atypia distributed on wide areas of superficial urothelium
atypia is present
no atypia but marked degenerative epithelial changes
there will be no target tumor tissue to work on
post-op. hematuria interacts unfavorably with BCG composition
of the risk of systemic absorption and sepsis
of the high risk of BCG reflux to kidneys while bladder irrigation
obstructive LUTS are common presentations and occur in association with carcinoma in situ
might present as perineal abscesses and fistulae
could be asymptomatic
venereal diseases increase the risk of urethral cancers
irritative bladder symptoms
obstructive bladder symptoms
palpable suprapubic mass on physical examination
painless profuse hematuria
40 - 55%
55 - 70%
70 - 85%
85 - 100%
0.6 - 2%
2 - 6%
6 - 10%
12 - 16%
infiltrative proximal penile urethral carcinomas
infiltrative distal penile urethral carcinomas
recurrent proximal penile urethral carcinoma after laser resection
T3/N2/M0 at bulbar urethra
10%
20%
30%
40%
working with organic chemicals and dyes
abuse of pain-control medications especially phenacetin
exposure to arsenic and aromatic amines
schistosomiasis
immediately before operation
immediately before incision and post-operative for 1 day
immediately before incision and post-operative for 15 days
immediately before incision and post-operative for 30 days
RB
cyclin A
HRAS
CD-44
adenocarcinoma
transitional cell carcinoma
squamous cell carcinoma
basal cell carcinoma
obesity
consuming artificial sweeteners
asbestosis
analgesic abuse
leiomyosarcoma
rhabdosarcoma
carcinosarcoma
neurosarcoma
often of high-grade sarcomas
often associated with muscularis propria invasion
due to vesical polyps occluding ureteric orifices
should be resected but not diathermized
the anterior urethra drains into the inguinal and pelvic nodes
the posterior urethra drains into the pelvic nodes
the proximal two-thirds drain into the external and internal iliac nodes
the distal one-third drains into the obturator nodes
adenocarcinoma
transitional cell carcinoma
squamous cell carcinoma
basal cell carcinoma