Tumors of kidneys are always cancerous.

Cause is unknown but mainly

due to carcinogen exposure. Tumor enlarges interfering with urine
outflow.
Triad of Symptoms: Hematuria, Flank pain, flank tumor
S/S of painless hematuria that can be intermittent and microscopic
or continuous and visible. Back pain that does not go away, weight loss
and unexplained fever.
Radical nephrectomy: Tx for a malignant renal tumor.
Partial Nephrectomy: pt w early stage or only one kidney
Laparoscopic nephrectomy: early stage. A cuff of bladder tissue is
removed as well bc the recurrence rate in any stump of ureter left
behind is high.
Complete Nephrectomy: removal of kidney and ureter
Surgery is the only cure
Stage 1 and 2: still in kidney

Stage 3 spread to lymph nodes

Embolization: occlusion of the renal artery to kill tumor cells.

Cryoablation: cryoprobe needles freeze and then thaw cancer cells,
eventually destroying cancer cells
Palliative Tx for extensive metastases. Tx is not curative.
Renla cysts are abnormal fluid filled sacs that arise from kidney tissue.
Acquired renal cysts are usually simple, round and sharp w smooth
walls
Renal cell carcinoma is irregular or multiloculated w irregular walls and
areas of unclear demarcation
Hx of renal insufficiency or a dialysis pt may develop PKD (hematuria
and hypertension)
Class 1: Benign Class 2: smooth w sharp margins
Class 3: clusters of cyst, irregular shaped, exploratory
surgery
Class 4: malignant solid
components
Excretory urography: iodine into urinary
Bladder cancer is associated with cigarette smoking and is the most
common
1

Papillary lesions are superficial and extend outward from the mucosal
layer
Nonpapillary: solid growth that grow inward, deep into the bladder wall.
The Worst
Metastases usually have not occurred as long as the tumor has not
penetrated the muscle wall of the bladder. Small superficial tumors
may be removed by cutting (resection) or coagulation (fulguration)
Cystoscopic exam every 2-3months
Pt w no recurrence for at least 1year require cystoscopic exam every
6months
Topical application is instilled into the bladder by means of a cath. Drug
remains concentrated and in contact w the bladder mucosa for about
2hours
Photodynamic therapy: laser destroys cells that have high
concentration of the photosensitizing
Cystectomy: removal of the bladder, necessary when tumor penetrates
muscle wall
Radical Cystectomy: removal of bladder, lower third of both ureters,
uterus, fallopian tubes, ovaries, anterior vag wall and urethra. Same in
men but prostate and seminal vesicles.
NG tube is removed once peristalsis has returned
Cutaneous urinary diversion: external ostomy bag to collect urine

Conventional ileal conduit

Cutaneous ureterostomy
Vesicostomy babies, temporary
Nephrostomy kidney 5-8, NEVER CLAMP

Continent urinary bladder

Indiana pouch bladder, self cath every 1-2h then 4-6h

Kock pouch bladder, self cath every 1-2h then 4-6h
Ureterosigmoidiostomy colon, cath in rectum, void every 2h,
NEVER enema, suppositories or laxatives

Neobladder: made from small intestine

BPH: prostate gland contains more than the usual number of normal
cells, when gland enlarges its known as Benign Postatic Hypertension

S/S takes more effort to void. P stream narrows and has decreased
force
DRE reveals an enlarged and elastic gland
Transrectal ultrasonography indicates prostatic size, helps rule out
possibility that a malignancy is causing the enlargement
terazosin(Hytrin): relax muscles in prostate and relieve urinary
symptoms
Goal of all surgical procedures: enlarge the bladder outlet
Continuous bladder irrigation is ordered after TURP to remove blood
clots and residual tissue. 3 Way Foley
TUNA: heat-induced coagulation necrosis
Prostatectomy
Transurethral: using a resectoscope to pass through penis and bladder
Suprapubic: incision in abdomen, bladder is opened and gland
removed by finger
Radical: incision through perineum between balls and rectum
Retropubic: low abdominal incision, bladder is NOT opened
Coude cath has curved tip and instillable lube
No more than 1000ml should be removed bc it causes bladder spasms
3 way cath: lumen, drainage, retention balloon
urine will be bloody at first so irrigate until clear.
Most prostatic carcinomas occur in the periphery of the gland. If
untreated tumor cells spread by way of the blood stream and
lymphatics to the pelvic lymph nodes and bone, particularly the
lumbar, pelvis and hips. Back Pain
Metastasis s/s: back pain or pain down the leg and does not go away,
Freq urination and weak urine flow.
Testing begins at age 50. 45 for Africans
Biopsy to know for sure if they have prostate cancer.
Gleason score: Norm 2-4

Aggressive 8-10

A radical prostatectomy, performed through a perineal or retropubic

approach, is the surgical preference if the tumor is large enough to be
palpated or if it has spread to adjacent tissue.
TURP: performed if the Pt has urethral obstruction and his physical
status is not amendable to Tx.
Hormone related
Strictures caused by STI, Trauma or congenital
Splaying: spraying outward
A voiding cystourethrogram shows presence of bladder diverticulum
(pockets/pouches)
Bougies: flexible
Nephrotic syndrome: hyperlipidemia, proteinuria (more in urine and
less in blood. Body wants to make more so lipids are also released.),
hypoalbuminemia and edema (in the morning). Damages to Glomeruli
and lowered immune system
S/S: anasarca, fluid buildup in lungs, oliguria <500, Striae, Foamy urine
Tx: corticosteroids bc its inflammatory, loop diuretics to decrease
sodium.
Acute glomerulonephritis: freq in children and young adults. Caused by
Strep.
There are decreased hemoglobin, slightly elevated BUN and serum
creatinine levels, elevated erythrocyte.
Not considered cured until urine is free of protein and RBC for 6months.
Return to activity after 1 month.
Pt needs carbs.
Acute Renal Failure: reversible w early aggressive tx. Caused by
prerenal disorder (shock dehydration) or Intrarenal conditions (meds)
or postrenal (obstructions)
Initiation phase: reduced blood flow to the nephrons to the point of
acute tubular necrosis, death of cells
Oliguric phase: 48h after and last for 10-14days leading to edema,
hypertension and cardiopulmonary and Azotemia
Diuretic phase: begins as nephrons recover. Excretion of wastes and
electrolyte imbalance continue to be impaired. Levels remain elevated.
4

Recovery Phase: 1 or more years

Chronic Renal Failure: intrarenal. Kidneys are so damaged that they do
not remove protein and electrolytes from the blood and do no maintain
acid-base balance. Stage 1-5. BUN and serum rise.
Osteodystrophy: bones become deminieralized
S/S of ARF: face is puffy, skin is pale. Ulcers and bleeding in GI
S/S of CRF: they smell like urine, muscle cramps, bone pain, go mental,
Seizures
IV of glucose and insulin helps movement of potassium within the cell.
Diet high in calories to maintain weight and spare protein.
Potassium is retained
Hemodialysis: transporting blood from the Pt through a dialyzer, a semi
membrane filter in a machine. 4-6h 3x a week
Fistulas are preferred over grafts bc they have better record remaining
patent and have fewer complications. 1-4months to mature
Distal is used to remove blood that is transported to machine. Proximal
is used to return blood
AV graft is a type of vascular access method that uses a tube of
synthetic material to connect a vein and artery in the arm. Used 14
days after, 3-5years life span
Palpate for a thrill
Note the color of the skin and nailbed
B4 discharge observe for disequilibrium syndrome
Nephrectomy: surgical removal of kidney, either a small portion or the
entire organ and surrounding tissue.
Radical Neph: removing entire kidney as a section of the ureter,
adrenal gland and fatty tissue
Kidney Transplant: any potential donor w a hx of hypertension,
malignant disease or diabetes is excluded from donation. The non
functioning kidney is left in place unless pt is hypersensitive.