From anterior to posterior:

  • The renal vein exits
  • The renal artery enters
  • And the renal pelvis exits the kidney

Right renal artery crosses behind the IVC

Left renal vein can be ligated from IVC because it has several colateral

Alpha Feto Protein and beta-HCG:

  • Are markers for non-seminomatous testicular CA

Testicular mass: Biopsy is orchiectomy via inguinal incision. (Never trans-scrotal)

Testicular cancer has 3 main types:

  • Germ cell tumors:
    • Seminoma: (most frequent testicular tumor)
    • Non-Seminoma: Embryonal, Teratoma, Choriocarcinoma, Yolk sac tumor
  • Non-germ cell tumor
  • Extra-gonadal tumors











Hematogenous/Lung + retroperitoneo




Orchiectomy + XRT

If mets: Cisplatin + Bleomicin

Stage I: orchiectomy, retroperitoneal node dissection

Stage II: orchiectomy + XRT + chemotherapy

Seminoma very radiosensitive:

  • Usually age 20-35
  • Rare in African-Americans
  • Most tumors are malignant
  • Even stage I gets RT (25% have occult metastasis)
  • Node (+) gets platinum chemo


  • Increase testicular CA x 3-14 folds.
  • Orchiopexy increase fertility but does not decrease CA risk.
  • Operate by age: ~ 2 yrs

Testicular torsion: Tx with bilateral orchiopexy

Varicocele: Remember L gonadal vein drains to L renal vein (may be obstructed by renal cell CA)

Right Gonadal Vein: drains into IVC

Ureteral injury: (iatrogenic or otherwise):

  • Avoid ureteral dissection (compromise blood supply)
  • Use absorbable suture (otherwise nidus for stones as with bile duct)
  • Stent and drain

Urethral injury:

  • Suspect with blood at meatus
  • Scrotal/penile injury
  • High-riding prostate.
  • Dx with retrograde urethrogram (RUG)
  • 1st Tx is do not place foley -> needs suprapubic cath

Bladder injury:

  • If pelvic fx, is usually extra-peritoneal
  • Generally need foley drainage only.
  • If no pelvic fx, is usually dome rupture (full bladder in MVA)
  • Needs OR, 3 layer closure, keep foley

Prostate CA: metastasis to bone are osteoblastic, radio-dense

Oxalate stones:

  • Most common (especially after ileum resection)

Mg Am Ph stones: 15%,

Urate stones: 8%

Proteus infection: (urease producing) -> struvite stones, "staghorn"

Renal Cell CA:

  • Triad of:
    • Abdominal pain (capsule stretching)
    • Mass
    • Hematuria
  • Can see erythrocytosis due to increase erythropoietin
  • Fever
  • HTN
  • Stouffer syndrome (decrease hepatic flow)


  • 95% made by kidney
  • Stimulated by hypoxia
  • Decrease production in ESRD

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