Bladder Disease Flashcards
Describe ways men and women differ in terms of bladder anatomy?
men - longer urethra, prostate
women - short urethra, no prostate
What’s the bottom part of the bladder called? Upper part?
lower = trigone upper = dome
WHat are urinary diverticula?
outpouchings of the bladder due to increased pressure pushing urine out into weak parts of the wall near where the vessels or ureters leave
What cyst can form in the dome of the bladder?
if a urachus remains patent after birth, you can get a urachal cyst
What’s the cancer concern with the a urachal cyst?
20-40% will have adenocarcinoma
What happens when there’s failure of development of the anterior abdominal wall?
exstrophy of the bladder
What cancer is associated with exstrophy of the bladder?
adenocarcinoma again
What type of tissue is an adenocarcinoma made of? Why is this unusual in the bladder?
it’s made of glandular mucosa - unusual because the bladder is transitilonal epithelia
Are diverticula of the bladder more often congenital or acquired?
acquired
What is a common cause of diverticuli?
benign prostatic hypertrophy increases the pressure in the bladder, promoting the formation of diverticula
What happens to the wall of the bladder with benign prostatic hypertrophsy?
the wall gets a trabeculated appearance due to pressure-induced hypertrophy
What two things can form in diverticula that will be hard to see on cytoscopy?
bladder stones or carcinoma
There are tons of things that can predispose to bladder inflammation. One is a fistula. Where do fistulas often form from?
the colon and the rectum
What is a very common cause of a colon-bladder fistula?
Crohn’s disease
the inflammation goes right through the wall of the colon into the bladder and the fibrosis that occurs afterwards forms a fistula
What is a cystocele and who is most likely to get them?
It’s when the bladder gets pushed down (along with the rectum) by a prolapsing uterus
most common in multi-partum women starting around age 50
What is the symptom triad for cystitis?
frequency
pain
dysuria
What is an important systemic effect of cystitis in the elderly population that doesn’t really occur in the young?
altered mentation
What are some other infectious causes of cystitic other than e coli, proteus or enterococcus that this guy talked about?
fungal: candida, cryptococcus (in immunosuppressed or post ABx)
chlamydia
mycoplasma
What are three causes of non-infectious cystitis?
radiation
chemotherapy agents - esp cyclophosphamide
interstitial cystitis (hunner ulcer)
How do acute and chronic cystitic differ pathologically?
acute - PMNs with suppurative exudate
chronic - lyphocyte hyperemia, epithelial hyperplasia, fibrosis, may be follicular or eosinophilic
What are the three thgins that can cause hemorrhagic cystitis?
radiation
chemo drugs - cyclosphophamide
adenovirus
What is a Hunner Ulcer and who gets them
it’s a persistent and very painful full thickness inflammation with fibrosis and fissures
more in women
what is the likely cause of a hunner ulcer?
probably autoimmune but we’re not sure
What is cystitis glandularis?
when the inflammation from cystitis induced metaplasic changes from transitional epithelia to glandular mucosa
What is malacoplaki? WHat’s it usually in response to?
when you get formation of soft yellow raised plaques in the bladder - usually in response to E coli and proteus
What cells will you see with malacoplakia? How do they form?
Michaelis-Gutman bodies - they’re macrophages that have an abnormality in their lysosomal enzymes so the e coli and proteus they gobble up don’t get broken down and they calcify within the lysosome. it makes the cell look like a bullseye.
What is cystitis cystica?
Sometimes instead of glandular metaplasia you just see cysts forming in the mucosa
What is by far the most common bladder neoplasm?
transistional cell carcinoma
others rarely: squamous cell carc, adenocarc, sarcoma, papillomas
Who is the most likely person to get a bladder cancer? WHY?
male aged 50-80 living in an urban setting
because they’re more likely to smoke! Tobacco is the number 1 contributor to bladder cancer
Where in the bladder do you see transitional cell carcinoma?
trick question - the whole uroepithelial lining is predisposed in a high risk patient, so they can be anywhere from the renal pelvis down to the urethra
Which is better to have: a papillary type or sessile type?
papillary! A sessile type is much more likely to infiltrate and metastasize
Besides tobacco use, what are some other factors that can contribute to bladder neoplasia?
aromatic amines/azo dyes like aniline dye from the rubber industry
chronic shistosomiasis in Africa
long term analgesic use
long term cytoxan exposure
possibly saccharin sweetener
WHat are the common symptoms of bladder neoplasia?
some will have fequency and dysuria
only 15% will have painless gross hematuria
Otherwise unexplained gross hematuria in a patient over 40 is what until proven otherwise?
urothelial carcinoma
What are some ways to evaluate a hematuria?
- urinalysis
- cytourethroscopy
- urinary cytology (beter for high grade carcinoma than low grade)
- evaluatoin of upper tracts with IV pyelogram with US or helical CT with urography
How do you grade transitional cell carcinoma?
Grade 1 - some cytologic and arch. atypia, but closely resemble normal trans. cells
grade 2 - still recognizable as transitional cells, but with mitoses and great loss of polarity
grade 3 - hard to tell they were ever transitional - disarray, loosening, fragmentation, mitoses, nuclear pleomorphism, tumor giant cells
How do you stage a bladder cancer?
Ta - papillary in mucosa TIS - flat in mucosa (worse) T1 - invades lamina propria T2a- invades superficial muscle T2b - invades deep muscle T3 - invades perivesical fat T4 - invades adjacent structures - through the bladder completely
What does N1, N2 and N3 mean for stagin bladder cancer?
Affecting nodes or not?
N1 is less than 2 cm
N2 is 2-5 cm
N3 is over 5 cm
What does M1 mean for staging bladder cancer?
has distant metastases
What is the most important factor in determining prognosis for bladder cancer?
stage Ta - 5 yr survival 90% T2 - 80% 5ys T3- 50-60% 5ys M1 - less than 10% 5ys
What is the treamtnet for a low stage transistional cell carcinoma?
transurethral resection
fulguration (cauterize the base)
intravesicular BCG to induce an inflammatory response for 6 weeks
What is the treatment of a high stage T2/T3?
cystectomy with node dissection
little benefit form post-surgical chemo
What is the treatment of a high stage/metastatic in a non-surgical patient?
chemotherapy - gemcitabine, cisplatin, methotraxate, vinblast, adriamycin ,cytoxan
Is screening reommended for bladder cancer in asymptomatic adults?
nope
What are the surveillance recommendations after a TURBT with or without BCG?
urine cytology and cytoscopy 3 months afterwards
periodic screening thereafter every 3-6 months
What is the general prognosis for a squamous cell carcinoma of the bladder and why?
70% 1year mortality! Terrible!
because they ofen cover a large area and are already deeply invasive at diagnosis
Again, what will predispose a bladder to adenocarcinoma?
urachal remnants or glandular metaplasia from chronic inflammation
Chronic shistosomiasis predisposes you to what cancer of the bladder? Why?
squamous cell - the shisto will penetrate the skin from contaminated water and enter venous circulation. it sets up shop in the portal system and the eggs are deposited in the wall of the bladder. cause a HUGE inflammation that sets up the milieu for squamous cancer down the line.
What are some common bacteria that cause urethritis?
neiseeria gonorrhea
chlamydia (M>F)
E coli and other enterics
What are the symptoms of urethritis?
pain, itchiness, frequency
What are two benign neoplasia or the urethra?
caruncles and papillomas
Who gets caruncles? What are they like?
females
red painful mass about 102 m in size at the urethral meatus
What is a papilloma associated with?
HPV
What is the most common malignant urethral neoplasia? Who gets it?
squamous cell carcinoma
elderly women
