Lower Urinary Tract Flashcards
What 3 things make up the lower urinary tract?
Ureters
Bladder
Urethra
Describe the epithelium the lines the lower urinary tract?
Transitional (urothelium)
- 5-6 layers of cells with oval nuclei with linear grooves
- Umbrella cells on the surface layer (flat)
What is a common congenital ureter anomaly that can result in hydronephrosis?
Ureteropelvic junction obstruction
What is a common benign mesenchymal tumor of the ureter and who does it occur in?
Fibroepithelial polyp
– children
What is a unique obstructive lesion of the ureters?
Retroperitoneal Fibrosis
What is Retroperitoneal Fibrosis?
Fibrosis throughout the retroperitoneum
==> traps and obstructs the ureters
Retroperitoneal Fibrosis is an obstructive lesion of the ureters. What 3 things can it be associated with?
- IgG4 related disease
- Meds -“methy”
- Autoimmune response to Ceroid (lipid compound)
Retroperitoneal Fibrosis is an obstructive lesion of the ureters. What are 3 possible things it is associated with?
- IgG4 related disease
- Meds -“methy”
- Autoimmune response to Ceroid (lipid compound)
What are some predisposing factors for inflammation of the bladder (cystitis)? (4)
- Calculi/obstruction
- Diabetes Mellitus
- Instrumentation
- Immune Deficiency
What are the 4 most common etiologic agents for Cystitis?
- E. coli
- Proteus
- Klebsiella
- Enterobacter
What defines the morphology of Acute Cystitis?
Hyperemia of the mucosa + neutrophils
What defines the morphology of Chronic Cystitis?
Mononuclear inflammatory infiltrates
What are the main symptoms of Cystitis?
Dysuria
Suprapubic pain
Urinary frequency
What are the 3 special forms of Cystitis?
- Interstitial Cystitis
- Malakoplakia
- Polypoid Cystitis
What are the 3 special forms of Cystitis?
- Interstitial Cystitis
- Malakoplakia
- Polypoid Cystitis
What is Interstitial Cystitis?
Symptoms of a UTI but NO infection with at least a 6 week duration
What are the defining morphologic features of Interstitial Cystitis?
Mucosal fissures with punctate hemorrhages
- Increased mast cells
Mucosal fissures with punctate hemorrhages and increased mast cells suggests what type of Cystitis?
Interstitial Cystitis
– UTI symptoms with NO infection present
What causes Malakoplakia and when is it seen?
Due to acquired defects in phagocyte function
– Seen with chronic infection or immunosuppression
How does Malakoplakia look?
Yellow raised plaques
What cells will be present with Malakoplakia and what will be inside them?
Foamy macrophages with Michaelis-Gutmann bodies inside
What are Michaelis - Gutmann bodies and what are they seen with?
Calcium deposits inside enlarged lysosomes
– seen with Malakoplakia
This type of Cystitis is due to defects in phagocyte function?
Malakoplakia
What type of Cystitis is due to bladder mucosa irritation from instrumentation (catheter)?
Polypoid Cystitis
Broad, bulbous polypoid projections after a catheter placement is consistent with what type of cystitis?
Polypoid Cystitis
– irritation of the bladder mucosa
Bladder cancers are usually urothelial (epithelial) in origin. Which sex is more often affected and is bladder cancer a single or multifocal malignancy?
More common in men
– Multifocal malignancy
What are some risk factors for developing Bladder Cancer?
Smoking
Exposure to Aryl Amines
Schistosoma infections
Analgesic/Cyclophosphamide use
What are some risk factors for developing Bladder Cancer?
Smoking
Exposure to Aryl Amines
Schistosoma infections
Analgesic/Cyclophosphamide use
What are 2 possible precursor lesions for Bladder Cancer?
- Non-invasive papillary tumors
2. Flat Non-invasive Urothelial Carcinoma In Situ
What is the most common precursor lesion for Bladder Cancer?
Non-invasive papillary tumors
What mutations take place with the Non-invasive papillary tumor bladder cancer precursor lesion to give rise to cancer?
RAS
FGFR3
PI-3 kinase
Mutations in RAS, FGFR3 or PI-3 Kinase that give rise to Bladder Cancer indicate that what precursor lesion was present?
Non-invasive Papillary Tumors
What precursor lesion is associated with decreased survival and why?
Flat Non-invasive Urothelial Carcinoma In Situ
– More commonly results in Detrusor Muscle Invasion == poor prognosis
What defines a worse prognosis for Bladder Cancers?
Detrusor muscle invasion being present
What mutations take place with Flat non-invasive Urothelial Carcinoma In Situ bladder cancer precursor lesion in order for bladder cancer to arise?
TP53
RB
Mutations in TP53 or RB that give rise to bladder cancer indicate that what precursor lesion was present?
Flat Non-invasive Urothelial Carcinoma In Situ
What is the most common symptom of bladder cancer?
Painless hematuria
What is the most common symptom of bladder cancer?
Painless hematuria
If there is a soft, gray, large protruding mass of mesenchymal origin in the bladder, what is it?
Leiomyosarcoma
Inflammation of the Urethra (urethritis) is due to what 2 general causes?
- Gonococcal
2. Non-Gonococcal
What are the 2 agents that are responsible for the Non-Gonococcal Urethritis?
Chlamydia
Mycoplasma
What is Urethritis (inflammation of urethra) usually present with in women and in men?
Women – cystitis
Men – prostatitis
What is a common syndrome and its symptoms when Urethritis is present?
Reactive Arthritis (Reiter Syndrome)
= Urethritis, Conjunctivitis, Arthritis
“can’t pee, can’t see, can’t climb a tree
What are some symptoms of Urethritis?
Pain, itching, urinary frequency
What is a small, red and painful lesion that can occur at the external urethral meatus of women?
Urethral Caruncle
What does a Urethral Caruncle lesion look like in women?
Small, red and painful lesion at the external urethral meatus
Urethral Caruncles are friable. With even the slightest of trauma, what may they do?
Ulcerate and bleed
What are benign urethral tumors?
Papillomas, even inverted ones
Condylomas
A proximal urethral carcinoma is similar to what carcinoma?
Bladder type (urothelial)
A distal urethral carcinoma is similar to what carcinoma?
Squamous and HPV related
