Microsoft PowerPoint - 02.Hematuria 文字.ppt

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叹教郁
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1 Hematuria 羅東博愛醫院泌尿外科張世琦

2 The Types of Hematuria True hematuria False hematuria Dye in urine Medication induced Strip test

3 The Types of Hematuria Gross hematuria vs. Microhematuria Sediment under microscopy RBC more than 0-2 /HPF Cause of hematuria Degree of hematuria The same importance of both

4 The Types of Hematuria Painful hematuria vs. Painless hematuria Obstruction or not Stone, blood clot, tumor, Inflammation The same importance of both Painful hematuria not equal to benign cause Painless hematuria not equal to malignant cause

5 The Types of Hematuria Initial hematuria, Terminal hematuria vs. Total hematuria The location of the hematuria source Initial hematuria: anterior urethra Urethritis, urethral foreign body, urethral stone, Terminal hematuria: posterior urethra, prostate BPH, CaP, TCC of prostatic urethra, Total hematuria: U-B, upper urinary tract TCC of U-B, ureter, renal pelvis, RCC,

6 The Studies for Hematuria Urine analysis Strip test: ph, Sugar, SpGr, O.B., Nitrate, Sediment: WBC, RBC, Crystal, IVP + PV Serum Creat < 1.8 Sonography Low abdominal sono: prostate, U-B, and bil kidney Urine cytology 3 sets in 3 different days Cystoscopy

7 The Treatments for Hematuria Dependent on the cause of hematuria

8 Case Presentation 胡 x 亭 ( 青島一號 ) 77 y/o, male Chief complaint Gross painless hematuria for 3 weeks Present illness Gross painless hematuria 3 weeks before presentation at China. U-B tumor with left hydronephrosis was informed and radical cystectomy was arranged for him.

9 Case Presentation Present illness (cont.) Came back to Taiwan and visited our OPD Diagnostic studies Urine analysis: RBC: 6-10 /HPF, WBC: 0-2 /HPF IVP+PV: Poor opacification of left collecting system Left hydronephrosis and hydroureter, nature to be determined Moderate residual urine amount due to BPH

10 Case Presentation Diagnostic studies (cont.) Urine cytology: (voiding urine) Atypical cell present x 1 set Inflammatory change x 1 set High grade TCC x 1 set CT scan of pelvis: Thinning of left renal parenchyma Left side hydronephrosis and hydroureter down to the UVJ level Soft tissue mass about 13 mm over left UVJ junction, R/O neoplasm from left U-B wall with obstructive uropathy

11 Case Presentation Diagnostic studies (cont.) Cystoscopy: No U-B tumor External tumor compression over left U-B wall just above the left UVJ TURBT: Necrostic tumor tissue over the intramural segment of left ureter R/O TCC of left L/3 ureter, intramural segment Left side R.P. (retrograde pyelogram) 5 Fr ureteral catheter through central part of tumor No suspicious filling defect over upper collecting system

12 Case Presentation Diagnostic studies (cont.) Urine cytology: (left renal pelvic urine) High grade TCC x 1 set Left side 6 Fr 24 cm D-J inserted for preserve left renal function ERPF (effective renal plasma flow / comprehensive renal function study) Total: ml/min Left: 64.3 ml/min Right ml/min

13 Case Presentation Treatment Left nephroureterectomy and partial cystectomy Left flank incision and low midline incision Partial cystectomy including the left UVJ Pathology reports Kidney: chronic pyelonephritis Left ureter: flat urothelial carcinoma in situ (3/M ureter) Bladder cuff: invasive non-papillary urothelial carcinoma, high grade, pt3a (tumor penetrates the muscularis propria to the adventitia) Cut margin: free of tumor

14 The End Thanks for Your Attentions!!

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