Urinary Tract Cancers

& Neurogenic Bladder

By: Rima Saker & Rasha Kashan
Group: 5
Course Name : Renal Systems
Course Code: NURS 373
 Urinary Tract cancers:
It include those of the
• Renal cancer
• Ureteral Cancer
• urinary bladder cancer
Renal Cancer
Renal Cancer:
• Renal cell carcinoma RCC’s are the most common type of malignant kidney
cancer, is form from epithelial cell.
• RCC is the most common type in adults 90-95% of cases .
• Risk Factors:
• Men are at high risk of kidney cancer more than women.
• Smokers

• Obesity

• Polycystic disease
• Hypertension
• Clinical Manifestation: Diagnostic
 Hematuria tests:
 Low back pain.  Ultrasonography
 Fatigue (tiredness)  IV urography
 Loss of appetite.  X-ray, CT or MRI

 Weight
 kidney tissue
loss.
(biopsy)
 Fever  Renal angiogram
 Medical Management:
Radiation
therapy or
Chemotherapy

Pharmacologic
treatment Surgical
Or Combination
treatment
 Surgical Management:
Perform Nephrectomy it can be:
• Radical nephrectomy is removal for whole kidney with tumor, adrenal gland and others…It can
be done by open excision or laparoscopic.
• Partial nephrectomy the surgeon removes only the tumor for those who have bilateral tumors.
• Nephroureterectomy is done for pt. that have transitional cell carcinoma.
• Kidney cancer is often treated by immunotherapy (interferon or interleukin 2), Radiation therapy,
and chemotherapy or a combination of these treatments.

Renal artery Embolization:

A catheter is injected into the renal artery with embolizing materials ( gelfoam, autologous blood
clot) used for patient that have metastatic tumor to block blood flow to the mass, taking away its
supply of oxygen and nutrients.
 Pharmacologic Therapy:

Depending on the stage of the tumor we make a treatment

Biologic treatment (immune cells) such as interleukin 2 more

effective for tumor a protein that regulates cell growth, is used alone
or in combination with lymphokine-activated killer cells WBC to
increase ability to kill cancer cells.

Interferon another biologic response modifier also may used.

Vaccination stimulate immune response tumor cells+ interleukin2 =

antibodies against renal cell carcinoma.
Ureteral Cancer
 What is Ureteral Cancer?
• Ureters are part of the urinary tract, and they carry urine produced
by the kidneys to the bladder.
• Is a type of cancer that begins in the cells that line the inside of
the tubes (ureters) that connect your kidneys to your bladder.
• 1 or 2 people out of 100 patients with cancer get this type
• It is more common in men than women
• Ureteral cancer mainly asymptomatic
  Causes:
• The exact cause of ureteral cancer is not known.
• Factors that can increase the risk of ureteral cancer include:
• Age especially older adults.
• Previous bladder cancer people who have been diagnosed with bladder cancer have
an increased risk of ureteral cancer.
• Smokers
• Exposure to a variety of chemicals and dyes found in factories that make leather
goods, textiles, plastics, and rubbers.
 Clinical Manifestation:

• Symptoms of ureteral cancer may include:

• Blood in the urine (hematuria)
• Weight loss (unintentional)
• Fatigue

• Urinary frequency and/or urgency

• Pain or burning discomfort during urination
• Back pain
 Diagnostic Tests:
• Physical Examination
• Imaging tests CT, MRI
• Urine tests
• Test for bladder cancer
• Use a thin, lighted tube to view the ureters( ureteroscopy)
• Intravenous pyelogram (IVP)
 Prevention:
• While some risk factors cannot be controlled, there are ways you can help to prevent
ureter cancer:

• Avoid exposure to chemicals: When possible, avoid exposure to industrial chemicals.

• Don’t overuse pain medications: Take only the recommended dose for the
recommended time. Talk to your physician about safe use of these medications.

• Don’t smoke: Smoking is a known causes of urinary tract irritation that may lead to
 Medical Management:
• Thereare options for all patients with ureteral cancer, grouped into
3 categories:

• Surgery

• Radiation Therapy

• Chemotherapy
Surgical Management:
Nephro-ureterectomy: when patients have been diagnosed with a mass or tumor
within the lining of the kidney and/or ureter, removal of the kidney, ureter and a
portion of bladder.
• Segmental resection of the ureters: If the tumor is small and localized, it is
possible to remove only the part of the ureter that contains cancer cells. Is done
using a general anesthetic. The surgeon may use open surgery or laparoscopic
surgery to complete a segmental resection of the ureters.
• Ureteroneocystostomy: If cancer cells are only in the lower part of the ureter, this
procedure removes only the lower part. The remaining section of the ureter is
reconnected to the bladder.
 Endoscopic Surgery: Endoscopic surgery is when the surgeon removes the tumor
using an endoscope and cutting tools passed through the endoscope. It done when
ureter that is low grade and at an early stage.
There are 2 ways to do endoscopic surgery:

For a ureteroscopy, the surgeon passes the endoscope through the urethra and bladder
then up to the ureter.

For a percutaneous endoscopy, the surgeon makes a cut in the skin on the side (flank)
or back of the body then passes the endoscope into the ureter.
Side effects of surgery
• bleeding
• an infection
• Pain
• a need to urinate more often than usual (frequent urination)
• narrowing of the ureters (stricture )
After surgery, radiation therapy and chemotherapy is usually prescribed to
eliminate any remaining cancer cells and reduce the possibility of recurrence.

combination of chemotherapy drugs that includes cisplatin is usually used to

treat cancer of the ureter. The most common chemotherapy combinations are:

cisplatin and gemcitabine (Gemzar)

If the cancer is detected in its early stages, or if cancer cells appear only on
surface of the ureter, laser or electro surgery are options.
- Laser therapy: A ureter scope is inserted through the bladder into the ureter.
- Electro surgery: Tumor is destroyed by an electric current, and adjacent
tissue is burned away.
Bladder Cancer
 Cancer of the Bladder:
• Is more common in people older than 55 years.
• It affects men more than women.
• Is a the development of a group cells in the lining of the bladder
that begin to grow and divide , they are in the urothelium of the
bladder.
• Bladder cancers are known urothelial carcinoma is the most
common type.
• Arising from the prostate, colon, and rectum in males and from the
lower gynecologic tract in females may metastasize to the bladder.
 Pathophysiology:
  Risk Factors:
• Tobacco is the most common risk factor associated with bladder
cancer, caused by carcinogenic chemicals.
• Exposure from aromatic amines which are used in the dye industry
and other chemicals found in the production of rubber textiles, or
paint.
• Recurrent or chronic bacterial infection of the urinary tract.
• Age (male)
• Pelvic radiation therapy.
• High cholesterol intake.
• Bladder stones.
 Clinical Manifestation:
• Hematuria is the most common symptom of bladder cancer.
• NO pain usually occur with bladder cancer.
• More frequent urination, difficulty voiding or urgency with
urination.
• If bladder cancer is caught late patient may experience back pain,
weight loss, tiredness, swelling, bone pain and other symptoms.
 Diagnostic Finding:
 Urine tests with a culture or microscopic exam.
 CT scan, MRI
 Ultrasonography

 Cystoscopy

 Biopsy
 Medical Management:
• Treatmentof bladder cancer depends on the stage of the
cancer and presence or absence of metastasis.
• Treatment involves usually a combination of surgical
treatment and pharmacological therapies.
• Radiation therapy is also used in combination with
surgery.
 Surgical Management:

• Transurethral resection of bladder tumor (TURBT) or fulguration: a surgical

incision or electrical current surgeon inserts a cystoscopy through the urethra into
the bladder to removes the tumor.
patient is given an anesthetic medication before the procedure.
• After removal the tumor a urologist may recommended an intravesicle treatment
Bacille Calmette Guerin (BCG) to produce local inflammatory and a systemic
immunologic response.
• Cystectomy Or Radical Cystectomy: is surgery to remove all or part of
the bladder.
• During a partial cystectomy, your surgeon removes only the portion of
the bladder that contains a single cancerous tumor.
• A radical cystectomy is an operation to remove the entire bladder and the
surrounding lymph nodes. In men, radical cystectomy typically includes
removal of the prostate and seminal vesicles. In women, radical
cystectomy may involve removal of the uterus, fallopian tubes, ovaries
and part of the vagina.
Pharmacologic Therapy:

- Chemotherapy with combination of methotrexate, Vinblastine (velban) and

cisplatin (platinol).
- Topical Chemotherapy (intravesical chemotherapy) delivers high concentration of
medication: mitomycin, doxorubicin to promote tumor destruction.
- BCG is an immunotherapeutic agent the most predominant agent for recurrent
bladder cancer. The optimal course for 6 week course, followed by a 3 week
course at 3 months.
- In high risk cancers administered in a 3 week course at 6, 12, 18, and 24months.
- Patient should allowed to eat and drink before the instillation, BCG is retained in
the bladder for 2 hours and then voided.
Radiation Therapy:

- Radiation therapy is a treatment or given combination during

bladder cancer surgery to reduce the risk of the cancer
returning or spread through circulatory or lymphatic system.

- Intractable hematuria is a common and severe complication in

patients with bladder carcinoma after radiation therapy a large
water filled balloon placed in bladder, hydrostatic pressure
therapy are used to relives hematuria .
Investigational Therapy:
Photodynamic therapy (PDT) is a promising option for minimal-
invasive bladder preserving treatment of urothelial cancer,
which combines a photosensitizer such as Photofrin,
haematoporphyrin derivates with red laser light to destroy
cancer cells.
Objectives:
Definition
Causes
Pathophysiology
Assessment and Diagnostic findings
Complications
Medical Management
Pharmacologic therapy
Surgical management
Definition:
It is a dysfunction that results from a lesion of the nervous system
and leads to urinary incontinence.
It may be caused by:

Spinal cord injury

Spinal tumor
Herniated vertebral disk
Multiple sclerosis
Congenital disorders (spina bifida or myelomeningocele)
Infection, or complications of diabetes mellitus
Pathophysiology
The two types of neurogenic bladder are

spastic (or reflex) bladder

flaccid bladder.
Spastic bladder
Is the more common type
Caused by:
Any spinal cord lesion above the voiding reflex arc (upper motor neuron lesion).
The result is:
A loss of conscious sensation and cerebral motor control.
A spastic bladder empties on reflex, with minimal or no controlling influence to regulate its activity
Flaccid bladder
Caused by
A lower motor neuron lesion, commonly resulting from trauma.
This form of neurogenic bladder is also increasingly being recognized in patients with diabetes mellitus.
The bladder continues to fill and becomes greatly distended, and overflow incontinence occurs. The bladder muscle does not contract forcefully at any time. Because sensory loss may
accompany a flaccid bladder, the patient feels no discomfort.
Assessment and Diagnostic Findings

Measurement of fluid intake, urine output, and residual urine

volume; urinalysis
Assessment of sensory awareness of bladder fullness and
degree of motor control.
Comprehensive urodynamic studies are also performed
Complications :
Infection resulting from urinary stasis and catheterization.
Long-term complications include :
urolithiasis (stones in the urinary tract)
vesicoureteral reflux
hydronephrosis
all of which can lead to destruction of the kidney
Medical Management
continuous, intermittent, or self-catheterization ;
use of an external condom-type catheter;
a diet low in calcium (to prevent calculi);
encouragement of mobility and ambulation.
A liberal fluid intake is encouraged to reduce the urinary
bacterial count, reduce stasis, decrease the concentration of
calcium in the urine, and minimize the precipitation of
urinary crystals and subsequent stone formation.
A bladder retraining program may be effective in treating a
spastic bladder or urine retention.
Use of a timed, or habit, voiding schedule may be established.
To further enhance emptying of a flaccid bladder, the patient may
be taught to “double void.” After each voiding, the patient is
instructed to remain on the toilet, relax for 1 to 2 minutes, and
then attempt to void again in an effort to further empty the
bladder.
Pharmacologic Therapy
Parasympathomimetic medications, such as bethanechol
(Urecholine), may help to increase the contraction of the detrusor
muscle.
Surgical Management
In some cases, surgery may be carried out to correct bladder neck
contractures or vesicoureteral reflux or to perform some type of
urinary diversion procedure.
 Reference
Brunner & Suddarths
Text book of Medical-Surgical Nursing