GU Pathophysiology Flashcards
Congenital genitourinary abnormalities of the ureters
Double and bifid ureters
Ureteropelvic junction (UPJ) obstruction (most common cause of hydronephrosis in infants/children)
Diverticula of the ureters
Congenital genitourinary abnormalities of the bladder
Vesicoureteral reflux (backwards flow of urine from the bladder to the kidneys due to incompetent vesicoureteral valve)
Diverticula –> predispose to stasis, infection, and formation of stones. Only congenital if due to abnormal development of the musculature of the bladder wall, but can also be acquired.
Exstrophy of the bladder where it communicates with outside the body or lies in an opened sac.
Urachal anomalies- bladder remains connected to the umbilicus by urachus.
Cystitis risk factors
Female Calculi Urinary obstruction Instrumentation Immune deficiency Diabetes
What are the most common infectious agents that cause cystitis
E coli!
Proteus
Klebsiella
Enterobacter
Other: Candida, mycobacterium tuberculosis, shistosoma, BCG (bladder CA treatment)
Cystitis clinical features
Classic triad of symptoms: Urinary frequency, lower abdominal pain, dysuria
Major complication is risk of pyelonephritis.
Interstitial cystitis
Severe suprapubic pain, urinary frequency, dysuria, and hematuria.
Unknown cause that is diagnosed in the absence of other possible etiologies (diagnosis of exclusion)
Fissures and punctate hemorrhages in the bladder mucosa with luminal distension –> late disease can cause transmural fibrosis and contracted bladder.
Cystitis: Malakoplakia
Chronic inflammation due to chronic bacterial infection with acquired defects in phagocyte function (bacteria are not destroyed effectively by macrophages)
On histology you will see macrophages with abundant granular cytoplasm and large phagosomes. Black dots with von Kossa stain.
Most common in immunosuppressed patients.
Bladder cancer risk factors
Cigarette smoking!! long term analgesic use, long term exposure to immunosuppressant (cyclophosphamide)
What are the two distinct precursor lesions to invasive urothelial carcinoma
- Noninvasive papillary tumors
- Noninvasive flat urothelial carcinoma
**in 50% of patients the cancer is already invasive at presentation and these are not seen.
Bladder cancer is a highly _____ cancer after excision
Recurrent
Bladder cancer clinical features
Most common presenting symptom is painless hematuria but is can progress to frequency, urgency, and dysuria.
Bladder cancer treatment
Low grade: diagnostic transurethral resection
High grade: intravesicular instillation of attenuated Mycobacterium bovis strain called bacillus Clamette-Guèrin (BCG) to destroy tumor
Invasive cancer/refractory to BCG: radical cystectomy
Prostate
Encircles neck of bladder and urethra
An androgen-dependent organ
Most hyperplasia of the prostate (BPH) arises from the ________ which most carcinoma arises in the _______
- Transitional zone
2. Peripheral zone
Prostatitis
Inflammation of the prostate
Can be acute bacterial, chronic bacterial, chronic abacterial (most common), and granulomatous
It is common to find histologic evidence of chronic or acute inflammation in the prostate of men with no symptoms.
Benign prostatic hyperplasia (BPH)
Extremely common nodular hyperplasia of prostatic stroma and epithelial cells of transition zone.
Not a premalignant lesion.
Hyperplasia thought to be due to decreased cell death not increased proliferation.
BPH clinical features
Major clinical problem is urinary obstruction which leads to increased risk of UTI and pyelonphritis.
Urgency, nocturia, difficultly starting/stopping flow, dysuria, dribbling.
Elevated PSA is often present.
Prostate cancer
Prostatic adenocarcinoma is the most common cancer in US men. It has a
It is androgen dependent
Precursor lesions is prostatic intraepithelial neoplasia (PIN)
Gleason system of prostate cancer grades
5 grades with grade 1 being most differentiated and grade 5 having no glandular differentiation.
Give two scores for most frequent and second most frequent pattern to form the gleason score.
Most common site of prostate cancer metastasis is ______-
bone
Usually osteoblastic
Screening for prostate cancer
Rectal exam
Prostate specific antigen (PSA) levels. Neither are very specific.
Testicular cancer
Most common tumor of 15-34 year old males.
Two major categories include: Germ cell tumors (95% of the time)
Sex cord-stromal tumors
Testicular germ cell tumors and precursor lesions
Most testicular germ cell tumors arise from a precursor lesion called intratubular germ cell neoplasia (ITGCN)
They are thought to arise in utero and then remain dormant until puberty when it progresses. They retain expression of genes important in maintaining pluripotency of stem cells.
Seminomas
50% of germ cell tumors
They are the most common and less aggressive.
They tend to form a bulky homogenous mass in the testes that has a uniform appearance.
Non-seminomas
More aggressive and heterogenous
Can be embryonal carcinoma (epithelial appearance), yolk sac tumor (glandular appearance) choriocarcinoma (multinucleate giant cytotrophoblasts) or teratoma
Usually a mixture of these types.
