Lecture 61 - Path of Lower Urinary Tract

Question 1

Diverticuli –
what is it?
how does one get it?
complications

Answer 1

Protrusion of mucosa through an area of weakening in the muscle in the bladder wall

Congenital
Acquired - secondary to obstruction

Complications –urinary stasis, can lead to infection, stones, vesicoureteric reflux

Question 2

Exstrophy
what is it?
treatment?

Answer 2

Developmental failure of the anterior wall of the abdomen; allows bladder to communicate with the exterior

Surgical correction = long term survival

Question 3

what is the most common abnormality of the bladder?

Answer 3

Vesicoureteral Reflux

Question 4

Vesicoureteral Reflux
what is it?
how does one get it?
Complications

Answer 4

Congenital or acquired defect in junction of ureters with the bladder; urine refluxes into the kidney during urination

Acquired – atony from spinal cord injury

Complications – pyelonehpritis, renal scarring, tubulointerstitial disease

Question 5

clinical effects of double ureterer or bifid ureureter?

Answer 5

no clinical significance

Question 6

Non infectious causes of cystits?

what antineoplastic drug is classically bladder toxic?

Answer 6

Radiation, Cyclophosphamide

Question 7

Infectious causes of UTI (infectious cystitis)

what parasite is classically associated

Answer 7

Bacteria - E Coli, enterobacter
Parasitic - Schistosomiasis

Fungal - candidta, cryptococcus in Immunocompromised patients

Question 8

histo differentiatatin between any acute vs chronic infection

Answer 8

Acute: PMNs

chronic: No PMNs; mainly lymphocytes and plasma cells

Question 9

two forms of chronic cystitis

Answer 9

Malakoplakia

Interstital Cystitis

Question 10

Interstital Cystitis

what is it?
men or women more common?

Answer 10

Form of chronic cystitis

Etiology – Unknown; possibly auto immune

Women&raquo_space; Men

Question 11

Malakoplakia
what is it?
what is it seen grossly?

eponym for pathognominc findings

Answer 11

Tellow Raised mucosal plaques

Plaques – foamy macrophages, giant cells, lymphocytes

Michaelis Gutmann Bodies

Question 12

What is papillary cystitis?

how does this histology differ from papillary shaped malignancies?

Answer 12

Inflammatory lesion from indwelling catheters

histo: thick bulbous cores;
Differs from Papillary malignacies which are thin cored

Question 13

Most common malignancy of the bladder ?

Exposures/risk factors for this?

classic presenation ?

Answer 13

Urothelial (transitional) carcinoma

RF: Smoking, Analine Dyes (printing and textiles) , Cyclophophamide

Painless hematuria

Question 14

Urothelial (transitional) carcinoma

treatment options

Answer 14

Cystectomy
TURBT
Topical therapies
Chemotherapy

Question 15

at what stage of cancer is cystecotmy necessary?

Answer 15

T2 and above;

invasion into the muscularis propria

Question 16

Two other malignant but rarer cancers of the bladder

which is a pediatric cancer ?

Answer 16

SCC of the Bladder

rhabdocarcoma – peds

Question 17

SCC of the bladder –

classic risk factor:

Answer 17

Schistosomiasis cystitis (an egyptian man presents with hematuria…)

Question 18

Rhabdosarcoma –
derived from what tissue?
what is seen histologicaly

Answer 18

Derived from muscularis layer of the bladder

Striations seen histologically

Question 19

A patient is diagnosied with PUNLMP, can this lesion progress to cancer?

Answer 19

No. This is a warning sign that patient is at higher risk for cancer, but not a pre-cancerous lesion

Question 20

what is a benign neoplastic lesion of the bladder?

Answer 20

Papilloma