Case Presentation
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Transcript of Case Presentation
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Ali RaziUrologist
Tehran Medical University2012
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Clinical Picture 81 y old male Acute Urinary retention.PMH :
TUR-P 4y ago , BPH on pathologic report and one time urethral dilatation after that .
Appendectomy 3 y ago.DM : Controlled by oral antiglycemic agents .
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Work Up
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UltraSonography
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Lt. kidney : NLRt. Kidney : Mild Hydronephrosis + 5 cm
simple cyst . Bladder : a 4*4*5 cm solid mass on Rt. Lat.
Side.
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MRI
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MRI
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MRI
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MRI
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MRU
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MRU
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On Cystoscopy , there is a ulcerated , sessile mass on the Rt. Lat. Side of bladder.
Bimanual exam before the TUR the bladder was not fixed but there is palpable pelvic
mass with suspicion of extravesical extension.TUR-Bx was done .
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Pathologic Report
High Grade Transitional Cell Carcinoma+
Deep muscle involvement
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Metastatic Work up
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CBC : Mild AnemiaLFT : NL.Serum electrolytes and Ca : In Nl. RangeCXR : Unremarkable Whole Body Bone Scan : No evidence of
Metastasis
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Further Discussion
Options ?
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First Option :
Radical Cystectomy
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Second Option
Bimodality Treatment
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Neoadjuvant chemotherapy +
Radical Cystectomy+
Adjuvant Chemotherapy
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Third Option
Three modality Treatment
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Chemotherapy+
Radiation+
TUR-BT
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Debates 1Resections :
Male : bladder- Prevesical fat-Prostate – Seminal Vesicles-Prostatic urethra Modifications : Prostate Sparing _ Seminal Vesicle Sparing
Female : Ant. Pelvic Exentration : bladder- Prevesical fat-Uterine – Ant. Vaginal wall- Ovaries-Urethra Modification : Uterine Sparing _ Ovarian sparing – Urethral
Sparing
Lymph node Dissection :
Number of lymph nodesLymph node density ( LND) :Conventional Vs. Extended pelvic lymph node
dissection
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Debates 2Contraindications for cystectomy
Unrespectable lymph node involvementFixed bladder to pelvic wallRectosigmoid involvement
Frozen Section for end of ureter
Prostatic urethral involvement
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Thank You