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Urology > Bladder Pathology > Flashcards

Bladder Pathology Flashcards

1
Q

What are the risk factors to developing bladder TCC?

A

SMOKING, aromatic amines (rubber), B-naphthylamine, benzidine, chronic cystitis, schistosomiasis (squamous type), pelvic irradiation, drugs (phenacetin, cyclophosphamide)

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2
Q

Non-papillary type bladder TCC is p53…

A

dependent (mutation)

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3
Q

Papillary type bladder TCC is p53…

A

independent

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4
Q

What is the pathophysiology of papillary type bladder TCC?

A

grow outwards from urothelium = can become malignant

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5
Q

What is the pathophysiology of non-papillary type bladder TCC?

A

grows horizontally and downwards = always malignant

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6
Q

what is the spread of bladder TCC?

A

local – to pelvic structures
lymphatic – to iliac and para-aortic nodes
haematogenous – to liver and lungs

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7
Q

what are the clinical features of bladder TCC?

A
  • Painless haematuria
  • Frequency
  • Urgency
  • Dysuria
  • Urinary tract obstruction
  • Pain from local nerve involvement or TCC of the kidney and ureter
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8
Q

what is the gold standard investigation for bladder TCC?

A

Cystoscopy with biopsy

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9
Q

what are the investigations for bladder TCC?

A
  • Cystoscopy with biopsy
  • Urine: microscopy/cytology for malignant cells
  • Ct Urogram
  • Bimanual EUA
  • MRI or lymphangiography
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10
Q

what is the criteria for T0 bladder TCC?

A

No evidence of tumour

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11
Q

what is the criteria for Ta bladder TCC?

A

Non invasive papillary carcinoma

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12
Q

what is the criteria for T1 bladder TCC?

A

Tumour invades sub epithelial connective tissue

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13
Q

what is the criteria for T2a bladder TCC?

A

Tumor invades superficial muscularis propria (inner half)

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14
Q

what is the criteria for T2b bladder TCC?

A

Tumor invades deep muscularis propria (outer half)

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15
Q

what is the criteria for T3 bladder TCC?

A

Tumour extends to perivesical fat

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16
Q

what is the criteria for T4 bladder TCC?

A

Tumor invades any of the following: prostatic stroma, seminal vesicles, uterus, vagina

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17
Q

what is the criteria for T4a bladder TCC?

A

Invasion of uterus, prostate or bowel

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18
Q

what is the criteria for T bl4badder TCC?

A

Invasion of pelvic sidewall or abdominal wall

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19
Q

what is the criteria for N0 bladder TCC?

A

No nodal disease

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20
Q

what is the criteria for N1 bladder TCC?

A

Single regional lymph node metastasis in the true pelvis (hypogastric, obturator, external iliac, or presacral lymph node)

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21
Q

what is the criteria for N2 bladder TCC?

A

Multiple regional lymph node metastasis in the true pelvis (hypogastric, obturator, external iliac, or presacral lymph node metastasis)

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22
Q

what is the criteria for N3 bladder TCC?

A

Lymph node metastasis to the common iliac lymph nodes

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23
Q

what is the criteria for M0 bladder TCC?

A

No distant metastasis

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24
Q

what is the criteria for M1 bladder TCC?

A

Distant metastasis

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25
Q

what is the management of pTa stage bladder TCC?

A

transurethral resection. and cystoscopy monitoring

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26
Q

what is the management of pT1 stage bladder TCC?

A

o Intravesical BCG –as a form of immunotherapy.
 Given after the main tumour has been removed by surgery.
 The vaccine is left in place in the bladder for 2 hours.

27
Q

what is the management of pT2 stage and above bladder TCC?

A

o <70 = radical cystectomy “gold standard” + Post-Op Chemo – M-VAC or neoadjuvant chemo - CMV
o >70, treatment is with radiotherapy

28
Q

what is frank haematuria?

A

presence of blood on macroscopic investigation (i.e. looking at the blood)

29
Q

what is microscopic haematuria?

A

where you can only see RBC’s on microscopic investigation

30
Q

what is Haemoglobinurea?

A

presence of free haemoglobin in the urine

31
Q

what is initial haematuria?

A

presence of blood in the urine when you first start micturating – this implies urethral damage

32
Q

what is terminal haematuria?

A

presence of blood in the urine at the end of the stream, and this suggests a problem with the prostate or bladder base.

33
Q

what do ribbon clots suggest?

A

suggest a ureteric cause

34
Q

what are kidney bleeds?

A

can mimic renal colic as the clot passes down the ureter.

35
Q

what are the kidney causes of haematuria?

A 
Trauma
Tumours
RCC
Calculus
Glomerulonephritis
Pyelonephritis 
Renal TB
Polycystic disease
Renal infarction
TCC
36
Q

what is the ureter cause of haematuria?

A

Calculus

37
Q

what are the bladder causes of haematuria?

A

Calculus
TCC
Acute cystitis
Interstitial Cystitis

38
Q

what are the prostate causes of haematuria?

A

BPH

Carcinoma

39
Q

what are the urethra causes of haematuria?

A

Trauma
Calculus
Urethritis

40
Q

what is a bladder prolapse/cystocele?

A

womens bladder bulges into her vagina

41
Q

what are the causes of cystocele?

A

age, heavy lifting, pregnancy, childbirth, chronic lung disease/smoking, FH, ethnicity, pelvic floor trauma, CTD, hysterectomy, cancer of pelvic organs

42
Q

what is the underlying mechanism of a cystocele?

A

• Occurs when the muscles, fascia, tendons and connective tissues between a woman’s bladder and vagina weaken, or detach.

43
Q

what are the different types of bladder prolapse?

A

midline defect, paravaginal defect, transverse defect, apical cystocele, medial cystocele, lateral cystocele

44
Q

what is a midline defect bladder prolapse?

A

cystocele caused by the overstretching of the vaginal wall

45
Q

what is a paravaginal defect bladder prolapse?

A

separation of the vaginal connective tissue at the arcus tendineus fascia pelvis

46
Q

what is a transverse defect bladder prolapse?

A

when the pubocervical fascia becomes detached from the top (apex) of the vagina.

47
Q

what is a apical cystocele?

A

located upper third of the vagina. The structures involved are the endopelvic fascia and ligaments. The cystocele in this region of the vagina is thought to be due to a cardinal ligament defect.

48
Q

what is a medial cystocele?

A

forms in the mid-vagina and is related to a defect in the suspension provided by to a sagittal suspension system defect in the uterosacral ligaments and pubocervical fascia.

49
Q

what is a lateral cystocele?

A

when both the pelviperineal muscle and its ligamentous–fascial develop a defect.

50
Q

what are the clinical of a cystocele?

A

a vaginal bulge, pelvic heaviness or fullness, hesitancy, incomplete urination, frequency, urgency, faecal incontinence, frequent UTI, back and pelvic pain, fatigue, painful intercourse, bleeding

51
Q

what investigations are used in diagnosis of cystocele?

A
  • pelvic exam
  • US
  • Voiding cystourethrogram
  • Urine culture
  • Grading – POP-Q
52
Q

what is the preventative management of cystoceles?

A

smoking cessation, losing weight, pelvic floor strengthening, treatment of chronic cough, maintaining heathy bowel habits – high fibre food, avoid constipation

53
Q

what is the non-surgical management of cystocele?

A

pessary, pelvic floor muscle therapy, dietary changes, oestrogen

54
Q

what is the surgical management of cystocele?

A

wall repair

55
Q

what are the causes of interstitial cystitis?

A
  • An antiproliferative factor
  • PAND
  • Associated with: IBS, Fibromyalgia, Chronic fatigue, Allergies, Sjogren
56
Q

what is the pathophysiology of interstitial cystitis?

A

Unknown
Several theories: autoimmune theory, nerve theory, mast cell theory, leaky lining theory, infection theory, and a theory of production of a toxic substance in the urine, neurologic, allergic, genetic, and stress-psychological

57
Q

what are the clinical features of interstitial cystitis?

A

Suprapubic pain, frequency, Painful intercourse, dysuria, Hesitancy, Pelvic pain worsen with filling of bladder, and improve with urination, Hunners Ulcers

58
Q

how is interstitial cystitis diagnosed?

A

Exclusion tests plus hydrodistention during cystoscopy with biopsy.

59
Q

what is the 1st line management of interstitial cystitis?

A

education, self care (diet modification), stress management

60
Q

what is the 2nd line management of interstitial cystitis?

A

physical therapy, oral medications (amitriptyline, cimetidine or hydroxyzine, pentosan polysulfate), bladder instillations (DMSO, heparin, or lidocaine)

61
Q

what is the 3rd line management of interstitial cystitis?

A

treatment of Hunner’s ulcers (laser, fulguration or triamcinolone injection), hydrodistention (low pressure, short duration)

62
Q

what is the 4th line management of interstitial cystitis?

A

neuromodulation (sacral or pudendal nerve)

63
Q

what is the 5th line management of interstitial cystitis?

A

cyclosporine A, botulinum toxin (BTX-A)

64
Q

what is the 6th line management of interstitial cystitis?

A

surgical intervention (urinary diversion, augmentation, cystectomy)

Urology (10 decks)

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