L60

Question 1

What is a diverticuli + associated complications?

Answer 1

Outpouching of bladder wall 
Complications: 
1. Urinary statis -> infection + stones
2. Reflux
3. Malignancy

Question 2

Describe congenital vs acquired diverticuli

Answer 2

Congenital: didn’t develop normal muscle in bladder wall, single
vs
Acquired: obstruction (prostate enlargement) -> muscle thickening, multiple

Question 3

What is exstrophy? Complications + surg

Answer 3

Fail to develop ant wall abdomen
Bladder connects to exterior
Complications: infection (duh), adenocarcinoma
Treat: surg

Question 4

What is vesi-cou-reteral reflux? Congenital vs acquired causes

Answer 4

Reflux of urine from bladder into ureters
Congenital: shorten the part of the ureter in the bladder (doesn’t compress when you pee)
vs
Acquired: bladder atony aka no bladder tone to create urine directionality (spinal cord injury)

Question 5

Complication of vesicoureteral reflux

Answer 5

Pyelo - duh

Renal scarring

Question 6

3 structural abnormalities of the ureter

Answer 6

Double
Bifid
Ureteropelvic jxn (where ureter connects to the kidney) obstruction - congenital, *most common cause hydronephrosis in kids

Question 7

What is cystitis? Common causes

Answer 7

Bladder infection 
Bacteria: EColi, enterobacteria
Fungal: IC pts
Schistosoma haematobium 
Anti-cancer drugs/radiation

Question 8

Gross vs microscopic appearance of cystitis

Answer 8

Red bladder
Micro: inflam cells in bladder epithelium
Acute = neutrophils
Chronic = lymphocytes + plasma cells, maybe cysts of these cells

Question 9

What type of disease is interstitial cystitis? M vs W. Treat?

Answer 9

Chronic cystitis
Freq pee, nocturia, urgency, pubic pain or pressure relieved by peeing
W > M
Difficult to treat

Question 10

Histo for interstitial cystitis

Answer 10

Edema in submucosa
Maybe punctate hemorrhages
Hunner’s ulcer (classic)

Question 11

What is malacoplakia?

Answer 11

Mass lesion in bladder or kidney: raised yellow plaques
Due to chronic infection - EColi maybe proteus
Aka common in IC pts

Question 12

Malacoplakia histo

Answer 12

Foamy macrophages (lipid inside)
Michaelis Gutmann bodies = Ca phosphate inclusions

Question 13

What is polypoid cystitis?

Answer 13

Inflam lesion of bladder due to irritation (indwelling catheter)
Don’t confuse for urothelial carcinoma

Question 14

Polypoid cystitis histo

Answer 14

Broad, edema polypoid projections

Vs urothelial neoplasm = narrow

Question 15

Urothelial cancer:
M vs W
Name top risk factors

Answer 15

M > W
SMOKING!!!!
Aniline dyes 
Chronic irritation: chronic cystitis, diverticula, parasites
Analgesic abuse

Question 16

How does urothelial carcinoma recur?

Answer 16

Original resected tumor doesn’t come back
The entire urothelium has increased chance of cancer
Different tumor, new location

Question 17

What are the types of flat urothelial neoplasms lesions you might see?

Answer 17

Flat lesions are either benign (low grade) or carcinoma in situ (high grade + confined to mucosa)
If goes past mucosa = invasive carcinoma

Question 18

What are the types of papillary urothelial neoplasms?

Answer 18

Papilloma = no chance recur, young pts
PUNLMP
Papillary carcinoma, low or high grade

Question 19

Histo of papillary urothelial cancers

Answer 19

Thin papillae (vs polypoid cystits)
W/ fibrovasc cores

Question 20

What is a PUNLMP? Histo

Answer 20

Papillary urothelial neoplasm of low malignant potential

• Thick epithelium w/o atypia
• No invasion
• Potential to recur

Question 21

Histo of low grade papillary urothelial carcinoma

Answer 21

Uniform nuclei
Scattered mitoses
Recur commonly but rarely invade

Question 22

Histo high grade papillary urothelial carcinoma

Answer 22

Many mitoses
Disordered cells
Dyscohesive cells
Invade stroma, mets possible

Question 23

Histo invasive urothelial carcinoma

Answer 23

Papillary or flat - once invade grouped together as invasive
Penetrate basement membrane -> into LP
See stromal nests

Question 24

How do you stage urothelial cancer?

Answer 24

Invasion and if mets

Question 25

Test q: the difference between which 2 stages of urothelial cancer determines treatment and thus prognosis?

Answer 25

T1 = invade LP
T2 = invade MP, here you’re going a partial or complete cystectomy
After T2 - all bad, treat same as T2

Question 26

Treat urothelial cancer

Answer 26

Resect: T1 vs T2
Topical: BCG or intravesicle chemo
Systemic chemo for high stage

Question 27

Symptoms of urothelial cancer

Answer 27

Hematuria

“Elderly male w/ 1 episode hematuria”

Question 28

Dx urothelial cancer

Answer 28

Urine cytology + cytoscopy

Both will find any evidence of flat or pap tumors

Question 29

What cancer does schistosoma hematobium give you?

Answer 29

Bladder SCC

Look for keratin pearls or eggs

Question 30

Bladder tumor in kids

Answer 30

Rhabdo-myo-sarcoma