VGHTC

Sabiston Textbook of Surgery, 19th ed

Chief Round

: R3

Contents
1

urologic anatomy for the general surgeon

endoscopic urologic surgery

urologic infectious disease

4
5

voiding dysfunction, BOO,BPH, and incontinence

male reproductive and sexual dysfunction

Department of Surgery

VGHTC

Contents

urolithiasis

urologic trauma

8
9

nontraumatic urologic emergencies

urologic oncology

Department of Surgery

VGHTC

VGHTC

Urologic Anatomy
for the general
surgeon

Department of Surgery

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UROLOGIC ANATOMY
Upper Abdomen and Retroperitoneum

Department of Surgery

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UROLOGIC ANATOMY
the surrounding organs:
Right

Left

Posterior

12th rib
psoas muscle

11th~12th rib
psoas muscle,

Anterior

pancreas tail and splenic

Liver
vessels,
hepatorenal ligament
(coronary ligament) lesser sac and stomach,
jejunum,
duodenum,
splenorenal ligament
hepatic flexure of the
colon

Department of Surgery

VGHTC

UROLOGIC ANATOMY

Department of Surgery

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UROLOGIC ANATOMY
URETER

Department of Surgery

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UROLOGIC ANATOMY
Ureter

lie on the psoas muscle

pass medially to the sacroiliac joints
cross the iliac vessels anteriorly
swing laterally near the ischial spines
pass medially to penetrate the base of the bladder
vasa deferentia pass anterior to the ureters
uterine arteries are closely related to the lower ureters

blood supply
The calyces, pelvis, and upper ureter: renal arteries
The lower ureter: common and internal iliac, internal
spermatic, and vesical arteries

UROLOGIC ANATOMY
Pelvic Anatomy: Bladder, Prostate,
and Seminal Vesicles

Department of Surgery

VGHTC

UROLOGIC ANATOMY
BLADDER
Capacity: ~500 mL
Cephalad: urachus, a fibrous remnant of the cloaca
Superior: covered by peritoneal reflection
Inferior: attached to the pubic bone by puboprostatic ligaments /
pubovesical ligaments
Artery:
hypogastric a.(internal iliac a.)superior, middle, and inferior vesical arteries
vaginal and uterine a.

Vein:
vesicle plexus internal iliac v.

Lymphatics:
The bulk of the lymphatic drainage external iliac LN
Anterior, lateral drainage obturator, internal iliac node
Base, trigone internal, common iliac groups

transitional epithelial cell = urothelium = bladder mucosa

lamina propria
muscularis propria = detrusor muscle

UROLOGIC ANATOMY
Pelvic Anatomy: Bladder, Prostate,
and Seminal Vesicles

Department of Surgery

VGHTC

UROLOGIC ANATOMY
PROSTATE
Weight:~20 g
Anterior: puboprostatic ligament
Inferiorly: urogenital diaphragm
Posterior: Denonvilliers' fascia x2 layers rectum
Zonal anatomy

peripheral zone
central zone
transitional zone
anterior segment(anterior fibromuscular stroma)
preprostatic sphincteric zone
*BPH develops from the median or lateral lobes, posterior lobe is
prone to cancerous formation.

ejaculatory ducts verumontanum

Department of Surgery

VGHTC

UROLOGIC ANATOMY
PROSTATE
Artery:
inferior vesical a.
internal pudendal a.
middle rectal (hemorrhoidal) a.

Vein:
periprostatic plexus, which has connections with the deep
dorsal vein of the penis and the internal iliac
(hypogastric) veins

neurovascular bundles (NVB): near the posterolateral

surface of the urethra and prostate gland
Department of Surgery

VGHTC

UROLOGIC ANATOMY
Groin, Genitalia, and Perineum

Department of Surgery

VGHTC

UROLOGIC ANATOMY
Male urethra
20 cm
four anatomic sections

Prostatic urethra
Membranous urethra
Bulbous urethra
penile urethra.

female urethra
4 cm
lies below the pubic symphysis
anterior to the vagina
voluntary external urinary sphincter:
lies within the urogenital diaphragm

Department of Surgery

VGHTC

UROLOGIC ANATOMY
Spermatic cord, contains:
vas deferens
internal and external spermatic arteries,
artery of the vas
spermatic vein
Lymphatics
Nerves
epididymis
1~3 seminiferous tubules rete testis in the mediastinum 12~
20 efferent ductules head of the epididymis single coiled
duct of the epididymis
testis
4 3 2.5 cm in diameter
Tunica albuginea, connects with the lobules within the testis
visceral tunica vaginalis serous tunica vaginalis
Department of Surgery

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VGHTC

endoscopic urologic
surgery

Department of Surgery

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Endoscopic
urologic surgery
Cystoscopy/cystourethroscopy(CUS)
rigid or flexible
adult
17Fr diagnostic rigid scopes
24 to 26 Fr operating resectoscopes

Cold cup biopsy forcep

Cone-tipped / straight ureteral catheter
Retrograde pyelography (RP): May be safely
performed to patients with a history of contrast allergy
To aid in identifying the ureters during surgery

Department of Surgery

VGHTC

Endoscopic
urologic surgery
Optical urethrotome: urethral stricture
incision
Electroresectoscope
cutting loop
Green Light laser
Holmium laser
bipolar resection system
Ellik evacuator
Continuous bladder irrigation (CBI)

Department of Surgery

VGHTC

Endoscopic
urologic surgery

Department of Surgery

VGHTC

VGHTC

Urologic Infectious
Disease

Department of Surgery

VGHTC

Urologic infectious
disease
Emphysematous Infection
DM
Emphysematous pyelonephritis
fulminant infection involving the renal parenchyma progress
to involve the perinephric space
most common causative agent: E.coli
percutaneous drainage
urgent nephrectomy: delay if improving with medical
treatment

Emphysematous pyelitis
gas within the renal collecting system but not within the
parenchyma
Department of Surgery

VGHTC

Urologic infectious
disease

Department of Surgery

VGHTC

Urologic infectious
disease
Emphysematous cystitis
gas-forming infection involving the bladder wall
urinary catheter drainage

Acute papillary necrosis

ischemic state involving the renal papillae
sloughed papilla into the collecting system and
ureter, causing obstruction
urgent drainage of the obstructed upper tract

Gas present in the urinary tract

anaerobic urinary infection, instrumentation or
catheterization, colovesical fistula
Department of Surgery

VGHTC

Urologic infectious
disease
Xanthogranulomatous Pyelonephritis
foamy, lipid-laden, macrophage infiltrate in the renal
parenchyma
chronic bacterial infection, usually in the presence of
stones and chronic obstruction
poorly functioning kidney
fistulization to the flank or adjacent organs
drainage often are unproductive, Nephrectomy is
usually indicated
cooling off period for active infection
risk of iatrogenic adjacent organ injury is high
the renal vessels cannot be individually dissected

Department of Surgery

VGHTC

Urologic infectious
disease
Epididymitis, Epididymo-Orchitis, Without
and With abscess
infected through ascending infection from the urinary
tract down the vas deferens into the scrotum
DDx:
testicular torsion
incarcerated inguinal hernia
testicular tumor with necrosis and inflammation

Scrotal ultrasound
abscess: surgical drainage +/- orchiectomy
testicular ischemia: exploration +/- orchiectomy

Department of Surgery

VGHTC

Urologic infectious
disease
Fourniers Gangrene
Necrotizing soft tissue infections of the genitalia
scrotal and genital pain, swelling, discoloration or
frank necrosis, crepitus, foul-smelling discharge
broad-spectrum antibiotic, supportive care, urgent
surgical debridement
separate the parietal tunica vaginalis of the testes
from the overlying necrotic dartos and skin and
preserve the tunical compartment intact
If the penile skin is necrotic, it can be dbrided down
to but not through the Bucks fascial layer
urinary tract source: urethral stricture with perforation
Foley
meshed STSG for the scrotum and nonmeshed thick
STSG for the penile shaft
Department of Surgery

VGHTC

Urologic infectious
disease

Department of Surgery

VGHTC

Urologic infectious
disease
Genitourinary Fungal Infections
diabetics, immunocompromised patients
extensive nosocomial and antibiotic exposure
invasive fungal infections of the bladder or
kidneys may be life-threatening
antifungal bladder irrigation
fungus balls in the renal colleting
system:direct irrigation or endoscopic removal

Department of Surgery

VGHTC

Urologic infectious
disease
Genitourinary Tuberculous Infections
Urine cultures from the first morning void
Upper urinary tract tuberculosis infection
may cause ureteral strictures, result in silent
obstruction and renal loss

Tuberculous epididymitis
chronic epididymitis results in cutaneous
fistula formation
test for an immunocompromised state,
including HIV
Department of Surgery

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VGHTC

Voiding Dysfunction,
BOO, BPH, and
Incontinence

Department of Surgery

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Voiding dysfunction
Postoperative Acute Urinary Retention
Cause:

Immobility
Narcosis
anticholinergic side effects of anesthetic agents
underlying subclinical bladder outlet obstruction,
local pain and spasm (typical after hemorrhoid or groin hernia
surgery)
transient prostatic swelling following coronary bypass surgery
or other procedures requiring cardiopulmonary bypass

Treatment:
Catheterization voiding trial second catheterization +
indwelling Foley catheter for 1 or more days
alpha blocker
adequate analgesics
urodynamic studies
cystoscopy
Department of Surgery

VGHTC

Voiding dysfunction
Urinary Incontinence
Urgency incontinence
loss of urine associated with an urge to void
overactive bladder / detrusor instability
anticholinergic / antimuscarinic
SE: dry mouth, constipation, confusion
Contraindication: narrow-angle glaucoma

Stress incontinence
loss of urine with movement, straining, or increase in
abdominal pressure
multiple vaginal deliveries, psot radical prostatectomy
pelvic floor exercises, sling, artificial urinary sphincter
Department of Surgery

VGHTC

Voiding dysfunction
Overflow incontinence
loss of urine when the bladder becomes full and
there is an inability to empty volitionally
palpate the full bladder, measurement of postvoid
residual by ultrasound or catheter drainage
the cause of the bladder distention: obstructive
versus detrusor dysfunction

Mixed incontinence

Department of Surgery

VGHTC

Voiding dysfunction
Neurourology and Voiding
Dysfunction of the Neurologically
Impaired
cerebral dysfunction: uninhibited detrusor
function
cervical cord lesions: detrusor-sphincter
dyssynergia (DESD)
lower lumbar / sacral lesions: bladder
flaccidity and impaired emptying
Department of Surgery

VGHTC

Voiding dysfunction
Benign Prostatic Hyperplasia and
Bladder Outlet and Urethral
Obstruction
LUTS (lower urinary tract symptoms)
little correlation between the measured
volume of the prostate and degree of
symptomatology that results
watchful waiting

Department of Surgery

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Voiding dysfunction

Department of Surgery

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Voiding dysfunction
medical therapy
-adrenergic blocking agents
orthostatic side effects

5-alpha-reductase inhibitors

block the conversion of testosterone to dihydrotestosterone

reduce the actual volume of the prostate
alters the serum PSA level (reduces it 50%)
maximal effects seen by 6 months

minimally invasive
standard surgical intervention
laser procedures
TURP
open simple prostatectomy

Department of Surgery

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VGHTC

male reproductive &

sexual dysfunction

Department of Surgery

VGHTC

Male Infertility
Infertility affects 15% ~ 20% of couples
Male factor: 50% of these cases.
Hx:
potential gonadotoxic exposure
urologic and sexually transmitted infections
trauma and prior surgery involving the pelvis, groin, and
genitalia
family history of infertility

PE:

Masculinization
meatal location
testicular size
presence and normalcy of the
epididymis and vas deferens
Varicocele
DRE
Department of Surgery

VGHTC

Male Infertility
Semen analysis

semen volume
consistency
sperm concentration
sperm total count
percentage motility
quality of sperm movement
sperm morphology
presence of RBC/WBC/bacteria

serum hormone studies

FSH
LH
testosterone
free testosterone
prolactin
Department of Surgery

VGHTC

Male Infertility
azoospermia: complete absence of sperm from
the semen
lack of sperm production
normal semen volume
elevated serum follicle-stimulating hormone (FSH) level

defects in sperm transport or ejaculation

ductal obstruction

iatrogenic injury (e.g., inguinal hernia repair)

ejaculatory dysfunction.

abnormal bulk semen parameters: reduced sperm

numbers, motility, or morphology

varicocele
antisperm antibodies
genital duct infection with pyospermia causing sperm dysfunction
gonadotoxic exposure

Department of Surgery

VGHTC

Male Sexual
Dysfunction
40% of men at 40y/o and 70% of
men at 70y/o
erectile dysfunction can be an early
indication of significant
atherosclerotic vascular disease

Department of Surgery

VGHTC

VGHTC

Urolithiasis

Department of Surgery

VGHTC

Urolithiasis
Risk factors
20~50y/o, males, Caucasians and Asians
family history of stone disease
Low fluid intake (<1200ml/day)
High animal protein intake
Low activity levels
Chronic UTI
primary hyperparathyroidism
Sarcoidosis
Familial renal tubular acidosis
hyperoxaluria
cystinuria
inflammatory bowel disease
short gut syndrome
medullary sponge kidney
Department of Surgery

VGHTC

Urolithiasis
Symptoms
acute onset pain, hematuria, and possibly
nausea, vomiting, and ileus.
Image:
KUB: 90% of stones are radio-opacity
Ultrasound: hydronephrosis
non-contrast CT: the stone and the dilated
collecting system proximal to it

Department of Surgery

VGHTC

Urolithiasis
Acute episodes: obstruction /
infection
Hydration
Analgesics
Decompressed urgently if with infection
retrograde ureteral stent insertion
percutaneous nephrostomy insertion
Ureteroscopic lithotripsy is contraindicated.

Department of Surgery

VGHTC

Urolithiasis
Treatment
Watchful waiting pilots
Extracorporeal lithotripsy (ESWL)
Intracorporeal techniques
Ureteroscopic stone manipulation
Flexible ureteroscopy and laser treatment
Percutaneous nephrolithotomy (PCNL)

Open/Laparoscopic stone surgery

Pyelolithotomy
Anatrophic (avascular) nephrolithotomy
Nephrectomy
Department of Surgery

VGHTC

VGHTC

Urologic Trauma

Department of Surgery

VGHTC

Urologic trauma
Urologic injury
10% of penetrating abdominal trauma cases
variable percentage of blunt abdominal
trauma cases
Renal injuries
1.4% to 3.25% of all trauma patients
4% to 8% of penetrating trauma patients

Department of Surgery

VGHTC

Urologic trauma

Department of Surgery

VGHTC

Urologic trauma
Renal Injuries
Imaging :CT scan

renal vasculature and of parenchymal lacerations

displaced or nonperfused parenchymal fragments
urinary extravasation
assessing function of the contralateral uninjured kidney
one-shot IVP may be obtained 10 minutes after the
injection of iodinated contrast

Treatment
Grade 1 ~ 3:routinely managed nonoperatively
Grade 4:controversial
hemodynamic
Interventional radiology options

grade 5:operative intervention

Department of Surgery

VGHTC

Urologic trauma
Ureteral Injuries

5% to 10% of penetrating abdominal trauma

uncommon in blunt trauma
gross hematuria may be absent
Imaging
Contrast-enhanced CT + delayed excretory phase
retrograde pyelography
IVP

Treatment
penetrating injuries / blunt avulsion: best managed by
surgical repair
Ureteral contusions:
prophylactic stenting to reduce progressive edema, occlusion, and
ischemia and postinjury extravasation

avoid devascularization to prevent ischemic injury

spatulated, tension-free anastomosis
Department of Surgery

VGHTC

Urologic trauma
Bladder Injuries
Gross hematuria
Penetrating injuries with laparotomy planned:
direct inspection of the injury site intraoperatively

Blunt trauma
stress cystogram to distinguish intraperitoneal from extraperitoneal
injury

Extraperitoneal rupture
pelvic fracture tearing and shear forces related to injury to the pelvic
ring
catheter drainage alone
repair may be necessary when failure of catheter management

Intraperitoneal rupture
sudden compression of the bladder by impact to the lower anterior
abdominal wall --> laceration of the bladder dome
exploration and repair

Complex bladder injuries

extensive lacerations of the bladder neck in women, or concomitant
injury to the lower bladder segment and rectum or vagina
require operative repair

Department of Surgery

VGHTC

Urologic trauma

Department of Surgery

VGHTC

Urologic trauma
exploration of the bladder:

midline anterior cystotomy

examine interior of the bladder
evacuate blood clot
assess critical structures
intramural ureters
ureteral orifices
passing feeding tubes up the ureters
intraoperative retrograde pyelography
bladder neck
close defects in the bladder wall in two layers
care should be taken when suturing the bladder near
the ureteral orifices or intramural ureter
intraoperative stenting
Injuries in continuity with rectal or vaginal injuries
omental flap interposition to prevent fistula
diversion with a large-bore Foley catheter (22~24Fr)
suprapubic cystostomy tubes

Department of Surgery

VGHTC

Urologic trauma
Urethral Injuries
suspicion of urethral injury
blood per the urethra or blood at the urethral meatus
following blunt trauma
pelvic fracture
straddle injury with perineal impact

penetrating trauma
severe pubic diastasis
marked vertical shear pelvic fracture

retrograde urethrography prior to Foley

catheter insertion

Department of Surgery

VGHTC

Urologic trauma
Treatment
primary immediate goal: provide urinary bladder
drainage suprapubic catheter
early catheter realignment for posterior urethral
disruption
delay repair

Department of Surgery

VGHTC

Urologic trauma
Genital Injuries
Early exploration and repair
Penile injuries

remove foreign material

cleanse the wound
hemostasis
repair defects in the tunica albuginea or urethra
Penile fracture: sudden flexion of the erect penis during sexual
activity

Scrotal and testicular injuries

scrotal ultrasound: whether the testis is ruptured

dbridement of devitalized parenchyma
closure of the capsule (tunica albuginea of the testis)
repair of the scrotum
Orchiectomy
thoroughly destroy the blood supply to the testis
no viable parenchyma available to salvage.
Department of Surgery

VGHTC

VGHTC

Nontraumatic
Urologic Emergencies

Department of Surgery

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Testicular Torsion
congenital deformity: bell clapper deformity
able to rotate freely on its spermatic cord pedicle
progressive edema and venous and arterial occlusion
testicular infarction

occurring usually in the pediatric, adolescent,

and young adult groups
DDx:
trauma,
epididymitis,
incarcerated hernia

Doppler ultrasound: absence of arterial flow

to the testis.
Department of Surgery

VGHTC

Testicular Torsion

Department of Surgery

VGHTC

Testicular Torsion
Best results: detorsion within 4 hours of the onset
of pain
8 ~ 12 hours: testicular viability and function
decreases significantly
Ultrasound: within 1 hour after presentation

surgical exploration if high suspicion and

ultrasound is not available in a reasonable
time frame
scrotal incision detorsion orchiopexy
orchiopexy on the contralateral side at the
same setting
Even a late torsion is suspected (e.g., several
days of fixed swelling, firmness), urgent
exploration is still indicated
Department of Surgery

VGHTC

Gross Hematuria With Clot Retention

Surgical Emergency:
with a hazardous degree of blood loss
with urinary clot retention

Etiology:

post-OP bleeding after TURP /TURBt

radiation cystitis
pelvic trauma
arteriocalyceal fistula

Department of Surgery

VGHTC

Gross Hematuria With Clot

Retention
Treatment
large-bore (20 to 26 Fr), three-way Foley
catheter for removal of clots from the bladder
by catheter irrigation
evacuation of clots under rigid cystoscopy and
resectoscope sheath
fulguration
Department of Surgery

VGHTC

Priapism
Definition:
Prolonged and often painful erection in the absence
of a sexual stimulus, lasting > 4~6h
may resolve spontaneously but, if it persists longer
than 2 to 3 hours, measures should be taken

Etiology:

sickle cell disease

drugs
pelvic or genital trauma
hematologic malignancy

Department of Surgery

VGHTC

Priapism
Low-flow priapism
Due to veno-occlusion, typical of sickle cell
patients
More common than high-flow priapism
sludging of blood in the corpora cavernosa results
in the accumulation of dark thick material
Ischaemic priapism > 4h: emergency intervention
Aspiration of blood from corpora:50ml portions
using a 18~20 gauge butterfly needle
Intracavernosal injection of 1 -adrenergic
agonist
medical treatment of the sickle crisis :
rehydration, oxygenation, analgesia, and
haematological input (consider exchange
transfusion).
Department of Surgery
VGHTC

Priapism
High-flow priapism
after penile or perineal trauma
fistula develops between a central corporal
artery and the vascular space within the
corpus cavernosum
Aspiration: arterial appearance and arterial
blood gas parameters
cool bath / icepack
embolization of the internal pudendal artery

Department of Surgery

VGHTC

VGHTC

Urologic Oncology

Department of Surgery

VGHTC

urologic oncology
Renal Tumor
Diagnosis
solid renal tumors > 3 cm: 65% ~ 75% represent renal cell carcinomas
Bx prior to surgical extirpation is reserved
DDx:
lymphoma
minimally fat-containing angiomyolipoma,
Sarcoma
pseudotumor

Paraneoplastic syndromes: found in 20% of patients with

RCC

hypercalcemia
anemia
Stauffer's syndrome(Nonmetastatic hepatic dysfunction)
ESR elevation
*cytokine
*Hepatic function normalizes after nephrectomy: 60% to 70%

Cystic renal masses: Bosniak classification

Department of Surgery

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urologic oncology

Department of Surgery

VGHTC

urologic oncology
Histologic Classification
Conventional
Clear cell
Granular
Mixed

Chromophilic/papillary
Type1
Type2

Chromophobic
Collecting duct
Medullary cell

Unclassified
*Sarcomatoid variants of almost all the histologic subtypes

Department of Surgery

VGHTC

urologic oncology
Partial nephrectomy
small, well-encapsulated, superficial, exophytic, polar lesion
positive margin and local recurrence rate: acceptable range < 5%

Radical nephrectomy
multiple tumors, large central tumor, postoperative hemorrhage,
necrosis, or loss of collecting system integrity

Open, laparoscopic or robotic technique

+/- regional lymph node dissection
+/- splenectomy, distal pancreatectomy, wedge
resection of the liver, duodenum, partial resection
of the colon, resection of flank musculature
+/- renal vein or vena caval tumor thrombus
resection

Department of Surgery

VGHTC

urologic oncology
Urothelial Cancer: Upper and Lower
Tract
Risk factors:
age
Tobacco smoking
chemical exposures:

aniline dyes
aromatic amine compounds
rubber, leather, dye and petroleum workers
Cyclophosphamide

chronic inflammation: SCC

Schistosomiasis:Schistosoma hematobium:
SCC
Department of Surgery

VGHTC

urologic oncology
Bladder cancer
TCC: 90%
consider upper tract imaging
long-term recurrence rate: 50%

SCC: 5% ~ 10%
schistosomal infection
chronic inflammatory
smoking

Adenocarcinoma: 1% ~ 2%
urachal in origin, typically seen at the upper bladder
dome
history of bladder exstrophy
evaluation of the GI system to ensure that the tumor has
not arisen from another organ system
Department of Surgery

VGHTC

urologic oncology
Symptoms:

gross painless hematuria: 75%

chronic irritative voiding symptoms
pelvic mass
flank pain: upper tract obstruction
flank mass

Dx:
Urine cytology / bladder wash cytology

Department of Surgery

VGHTC

urologic oncology
Treatment:

TURBt
BCG intravesical immunotherapy: initial + maintenance
Intravesical Chemotherapy: Mitomycin C
immediately following standard TUR
Radical cystectomy: muscle-invasive bladder cancer
+/- neoadjuvant chemotherapy
male: cystoprostatectomy
female: cystohysterectomy
+/- urethrectomy
urinary diversion
ileal conduit
cutaneous catheterizable reservoirs
orthotopic bladder substitution / neobladder:
Studer pouch
Chemotherapy: MVAC or GC
Department of Surgery

VGHTC

urologic oncology
Upper tract TCC
Treatment:
Surgical resection
+/- neoadjuvant chemotherapy
Nephroureterectomy, including ureteral orifice

distal ureterectomy + ureteral reimplantation

endoscopic ablation

Department of Surgery

VGHTC

urologic oncology
Prostate Cancer
Adenocarcinomas(95%)
Dx:
Asymptomatic
DRE, PSA, discovered incidentally during radical
cystectomy or TURP

Risk factors:
family history : Y chromosome
advancing age
African American heritage
Department of Surgery

VGHTC

urologic oncology
Prostate Cancer
Screening for prostate cancer: PSA and DRE
recommended by the American Cancer Society
and American Urologic Association
in all men older than 50 years
with elevated risk factors: 40 / 45 years
PSA
normal-range

50 y/o: 2.5ng/mL
60 y/o 3.5ng/mL
percentage of free PSA

>25%: <10% risk

<10%: >50% risk
PSA velocity: <0.75 U/year

improve survival, but controversy

Department of Surgery

VGHTC

urologic oncology
Prostate Cancer
Dx:
TRUS Bx
Gleason score: two highest and most prominent
grades observed
CT scan: lymph nodes metastasis
Bone scan: bone metastasis

Department of Surgery

VGHTC

urologic oncology
Prostate Cancer
Tx:
localized disease

watchful waiting: low PSA level, low-grade, low-volume tumor

brachytherapy
cryotherapy
radical prostatectomy
External beam therapy

advanced disease
androgen ablation therapy

luteinizing hormone-releasing hormone (LHRH) agonists

bilateral simple orchiectomy

Castration-Resistant Prostate Cancer

chemotherapy

Department of Surgery

VGHTC

urologic oncology
Penile, Urethral, and Other Genital
Malignancies
Penile cancer

Uncommon
SCC
chronic phimosis and local infection: HPV
circumcision, distal penectomy, or radical
penectomy +/- inguinal lymphadenectomy
Urethral cancer
women > men
TCC
partial or total urethrectomy

Squamous cell cancers of the scrotum

chimney sweeps: carcinogenic effects of inspissated soot
Local excision

Department of Surgery

VGHTC

VGHTC