• Clinical Presentation
  • Microscopic hematuria [60-90%]
  • One third will complain of flank pain
  • Ten percent found incidentally
• Diagnosis
  • Intravenous urography
    • Filling defect of renal pelvis or ureter
    • Stippled calcifications of collecting system mass
  • Retrograde pyelography
    • Aid to IVU, greater sensitivity, allows for cytology and brush biopsy of lesion
  • CT scan
    • Limited role in ureteral mass, improved with spiral study or CT urolography
  • Ultrasound
    • Delineate stone from soft tissue mass
  • Brush biopsy and cytology
    • Filling defect and positive cytology provides diagnosis
    • Positive cytology in absence of mass requires further evaluation
  • Ureteroscopy
    • Direct visualization and biopsy of the upper tracts
    • Technically limited by location of the lesion in the collecting system
  • Filling defect differential diagnosis
    • Radiolucent calculi, blood clot, vascular compression, sloughed papillae, fungus ball, TB, ureteritis cystica

References

• Carroll PC, Dixon CM. Surgical anatomy of the male and female urethra. Urol Clin North Am 19:339-346, 1992.
• Cataluna WJ: Modified inguinal lymphadenectomy for carcinoma of the penis with preservation of saphenous vein: Technique and preliminary results. J Urol 140:836, 1988.
• deKernion JB, Abi-Aad AS: Controversies in ilioinguinal lymphadenectomy for cancer of the penis. Urol Clin North Am 19:319-324, 1992.
• Forman JD, Lichter AS: The role of radiation therapy in the management of carcinoma of the male and female urethra. Urol Clin North Am 19:383-390, 1992.
• Gerbaulet A, Lambin P: Radiation therapy of cancer of the penis: Indications, advantages, and pitfalls. Urol Clin North Am 19:325-332, 1992.
• Johnson DE, Ames FC: Groin Dissection. Chicago, Yearbook Medical Publishers, 1985.
• Lowe FC: Squamous cell carcinoma of the scrotum. J Urol 130:423, 1983. Russo P, Gaudin P: Carcinoma of the penis: Diagnosis and staging. Cont Urol 4:12-31, 2000.
• Schellhammer PF, Jordan GH, Schlossberg SM: Tumors of the penis. In: Walsh PC, Retik AB, Stamey TA, Vaughan ED, eds. Campbell's Urology, 6th ed. Philadelphia, Saunders, 1992, pp 1264-1298.
• Skinner EC, Skinner DG: Management of carcinoma of the female urethra. In: Skinner DG, Lieskovsky G, eds. Diagnosis and Management of Genitourinary Cancer. Philadelphia, Saunders, 1988, pp 490-497.

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