Carcinoma urinary bladder

HEMATURIA and Carcinoma Urinary Bladder

Learning Objectives ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Bladder tumours ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Types ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Urothelial tumours ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Clinical features ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Hematuria ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

3 glass test ,[object Object],[object Object],[object Object],[object Object]

[object Object],[object Object],[object Object]

Cause may be any where in urinary tract ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Surgical Causes ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Surgical Causes ,[object Object],[object Object],[object Object],[object Object],[object Object]

Surgical Causes ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Surgical Causes ,[object Object],[object Object],[object Object],[object Object]

Medical Causes, cause of hematuria may not be in urinary tract but outside it ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Points in history ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Management Steps ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Clinical examination ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Workup ,[object Object],[object Object],[object Object]

flow cytometery ,[object Object],[object Object],[object Object],[object Object]

Management Steps ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Advantages of US ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Disadvantages US ,[object Object],[object Object],[object Object]

Imaging: US findings ,[object Object],[object Object],[object Object],[object Object]

IVU ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

IVU ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

IVU ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

IVU Findings ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Management Steps ,[object Object],[object Object],[object Object],[object Object],[object Object]

Cysto-urethro-scopy ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Management Steps ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Management Steps ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Open excision or biopsy ,[object Object],[object Object],[object Object],[object Object]

3 biological behaviral pattrens Non-muscle invasive (superficial) disease Muscle invasive disease Flat noninvasive CIS (primary CIS) pTa, pT1 pT2+ CIS 70% new cases 25% 5% Good prognosis Bad, 5 yr survival 50% Poor unless treated early Recur 70%, invade 15% Invade, metastasize Invade, metastasize Exophytic, papillary Single, multiple Solid, large,1 or more Irregular, ulcerated Flat, velvety mucosa, angry looking vessels Pedunculated (stalk) Broad base Field change +/_ (con CIS) Lamina propria muscularis Intra epithelial Comptete resection Persist on Bim Exam Met death 30-50% 50% deaths mets Down stage/salvage cyst Endoscopic + intravesical Primary surgical treatme Endo+intrrav+/-surgry

Stage wise treatment Stage Description Traetment Tis Ca insitu Complete TURBT Intravesical BCG-> repeat-> RC* Ta Single, low to moderate grade, not recurent Complete TUR alone Ta Large, multiple, high grade, recurrent Complete TUR intravesical chemo- or immunotherapy T1 Complete TUR-> intravesical chemo- or immunotherapy T1G3 Complete TUR ->Intavesical BCG -> repeat ->radical cystectomy T2 ,[object Object],T2-4 ,[object Object],[object Object],[object Object],[object Object],[object Object],Any T, N+, M+ ,[object Object]

Metastatic disease ,[object Object],[object Object],[object Object]

Intravesical Chemo- or Immunotherapy ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Systemic Chemotherapy ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

New Systemic Chemotherapy ,[object Object],[object Object],[object Object]

Radical Cystectomy ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

diversions ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Open Procdures / Biopsy ,[object Object],[object Object],[object Object]

Radiation ,[object Object],[object Object],[object Object],[object Object],[object Object]

Management of associated problems ,[object Object],[object Object],[object Object],[object Object]

Follow Up ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Resident’s Role ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

remember ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Hematuria of obscure origin ,[object Object],[object Object],[object Object],[object Object],[object Object]

Carcinoma urinary bladder

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Carcinoma urinary bladder