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Methodological Instructions for Students

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Methodological Instructions for Students

Theme: Tumors of urinary bladder.

Aim: should know to diagnose, principles of treatment of tumor of urinary bladder; to know methods of operation.

Professional Motivation:

In statistics tumors of urinary bladder comes to 35-50% of all tumors of urology. Cancer of urinary bladder is often noted in people older than 40 years; men suffer more than women 3-4 times from this disease.

Basic Level:

1. Anatomy, physiology of urinary bladder.

2. To know anamnesis (life history) and should know to do physical method of investigation.

3. X-ray, instrumental, laboratory, morphological methods of investigation which is used to diagnose tumors of urinary bladder.

4. You should know etiological, pathogenical, symptomatical therapy: medicamental, radiational, operative methods of treatment.

Student's Independent Study Program
            1. I. Objectives for Students' Independent Studies

You should prepare for the practical class using the existing textbooks and lectures. Special attention should be paid to the following:

1. Etiology and pathogenesis of tumors of urinary bladder.

The development of multiple tumors at different sites in the urothelium represents similar tumorigenic changes occurring either simultaneously or successively within single cells at multiple sites.

In the process of initiation of cells transformation, a normal cell is changed into a latent or dormant malignant cell. This is usually the results of multiple, complex interactions of a number of carcinogens acting over a period of time rather than the result of exposure to a single specific carcinogen.

The vast majority of bladder tumors (98 %) are epithelial in origin; 92 % of these are transitional cell carcinoma, 7% are squamous cell carcinoma, and 1-2% are adenocarcinoma. Sarcomas, pheochromocytomas, malignant lymphomas, mixed mesodermal tumors, and primary carcinoid tumors account for most of the nonepithelial tumors.

2. General clinical symptoms tumors of the bladder.

The predominant symptom is hematuria, which is both painless and macroscopic in 75-80% of patients. Blood is usually noted throughout urination, although occasionally it may be present only at the beginning (initial hematuria) or at the end ( terminal hematuria) of urination. In 17% of patients, bleeding may be so severe that clot retention develops. Symptoms of vesical irritability, usually the result of a secondary bacterial infection, are present in one-fourth of patients presenting with bladder cancer. These symptoms include increased urinary frequency, dysuria, urgency, and nocturia. Pain in the flank may be noted if the growth obstructs a ureteral orifice and produces hydronephrosis. Twenty percent of patients have no specific symptoms, and malignant disease is discovered during an evaluation for occult hematuria, pyuria, etc.

3. Diagnostic tumor of the bladder.

Although debate has been increasing in recent years regarding the cost-effectiveness of excretory urography in screening patients with various urologic disorders, the first step in diagnosing a bladder tumor is still an excretory urogram. The procedure aids in eliminating the upper urinary tract diseases (renal parenchyma, ureters, pelves, and calices ) as the source of the patient`s symptoms. The excretory cystogram, which is an integral part of the urographic studies, frequently raises the suspicion of a bladder tumor by demonstrating an irregular radiolucent filling defect.

Radiographic procedures other than excretory urography are generally perfomed to aid in assessing the extent of the malignant growth rather than to help make a diagnosis. However, increasing experience with ultrasonographic assessment of bladder tumors suggests that ultrasonography may be helpful in diagnosing cases in which cystoscopy cannot be perfomed or is inconclusive, as in patients with tumors located in a diverticulum.

Cystourethroscopy almost always reveals the tumor. Methodical inspection of the entire vesical and uretheral urothelium should be performed before biopsy. Ideally, tissue from the base of the tumor, including muscle, should be included with the specimen. In addition, biopsies of the primary tumor should include adjacent normal-appearing epithelium. inadequate biopses can severely restrict the pathologist`s ability to assess the extent of the disease and can thereby adversely affect the patient`s prognosis, since improper therapy is likely to result.

4. Methods of operative treatment of urinary bladder`s tumor.

Transurethral resection of the malignant areas, followed by a course of intravesical instillations of thiotepa, shoud be considered when the lesion is confined to a relatively small( to 5 cm), reasonably well delineated area of the bladder; the tumor does not involve the prostatic urethra, vesical neck, or either ureteral orifice; the results of cytologicstudies of urine specimens from the upper tracts are negative; and the symptoms are not excessive. Superficial bladder carcinoma is usually managed by transurethral resection and fulguration.

Endoscopic resection is indicated only in highly selected patiens in whom the malignant disease is usually of intermittent grade and has penetrated only the most superficial portion of the mucularis. When the invasive tumor is solitary, has well-defined margins, occurs away from the fixed portion of the bladder (base, trigone, or neck), and allows for wide surgical excision, a partial or segmental resection may be employed.

Radical cystectomy with urinary diversion is usually the treatment of choice for invasive bladder carcinoma. Five-year survival rates following external radiotherapy alone have been in the range of 17-23%.
      1. ^

        II. Tests and Assignments for Self-assessment

1. What method of investigation gives the complete information of urinary bladder's


A. Ultrasound screening.

B. Doppler graphy.

C. Retrograde cystography.

D. Cystoscopy.

E. Cystography.

2. Main symptom of urinary tract's tumour in retrograde cystography is:

A. Deffect wall of urinary bladder.

B. Calcium deposits.

C. Diverticulum of urinary bladder.

D. Microcyst.

E. Before bladder.

Multiple choice. Choose the correct answer/statement:

Real life situation to be solved:

1. Patient M., at the. age of 44; during cystoscopy investigation-tumor 1,5/2 cm is noted with elements of necrosis, diameter of tumor is large. What is the diagnose? What are the tactics of doctor in polyclinic, treatment of this patient?

2. Patient C., at the age of 54, admitted in urological department, complaints with blood

after urine; in retrograde cystography defect is noted in the region of neck of urinary

bladder. What is the diagnose? What are the tactics of treatment?

III. Answers to the Self-assessment.

The correct answers to the tests:

l. D.

2. A.

The correct answers to the real life situations:

1. Tumor of urinary bladder. Patient should be sent to special urological department, necessary to provide transvasical resection of urinary bladder and next we should do radiational therapy.

2. Tumour of neck of urinary bladder we should make cystoscopy. When diagnosis is confirmed we should make resection of urinary bladder (in region of urinary bladder's neck).

Visual Aids and Material Tools:

1. Slides.

2. X-ray photographs.

3. Cystography (tumours of urinary bladder).

4. Retrograde cystography (tumors of urinary bladder).

5. Medial chart of patient.

Students' Practical Activities;

Students must know:

1. Etiology, pathogenesis tumor of urinary bladder.

2. Path. anatomy of urinary bladder's tumor.

3. Classification of urinary bladder's tumor with stages and clinical groups.

4. Symptomatology and clinical symptoms of urinary bladder's tumor.

5. Diagnosis of urinary bladder's tumor.

6. X-ray symptoms of urinary bladder's tumor.

7. Endovisical symptoms of urinary bladder's tumor.

8. Differential diagnosis of urinary bladder's tumor.

9. Tactics of therapist and urologist in case of haematuria.

10. Treatment of urinary bladder's tumour: chemical-radiational treatment.

11. Methods of operative treatment of urinary bladder's tumor.

12. Path. metastases of urinary bladder's tumor.

Students should be able to:

1. Select main syndromes and symptoms of urinary bladder's tumor.

2. Reform clinical diagnosis.

3. Make differential diagnosis.

4. Note program of extra methods of investigation.

5. Know tactics of treatment in tumors of urinary bladder.

6. Know practical knowledge: palpation, percussion of urinary bladder, to note cystography and results of cystoscopy.


Methodological Instructions for Students iconMethodological Instructions for Students

Methodological Instructions for Students iconMethodological Instructions for Students

Methodological Instructions for Students iconMethodological Instructions for Students

Methodological Instructions for Students iconMethodological Instructions for Students

Methodological Instructions for Students iconMethodological Instructions for Students

Methodological Instructions for Students iconMethodological Instructions for Students

Methodological Instructions for Students iconMethodological Instructions for Students

Methodological Instructions for Students iconMethodological Instructions for Students

Methodological Instructions for Students iconMethodological Instructions for Students

Methodological Instructions for Students iconMethodological Instructions for Students

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