Lower Urinary Tract Flashcards
What is cystocele
Protrusion of bladder into the vagina
What happens in a ureteropelvic junction obstruction
Abnormal organization of small muscle bundles or excess stromal deposits. Associated with agenesis of opposite kidney
Chronic inflammation of the ureter can lead to…
ureteritis follicularis – Fine granular mucosal changes w/ lympho. aggregates
ureteritis cystica – fine cysts develop in the ureter walls
Name for benign tumors of the ureter
Fibroepithelial polyps
Explain sclerosing retroperitoneal fibrosis
- Fibrous proliferative inflammatory process encasing the retroperitoneal structures.
- Autoimmine, Drug Triggered
- Prominent lymphocytic infiltrate w/ germinal centers and plasma cells
Causes of bladder diverticula
- Congenital focal failure of normal musculature
- Longstanding increase in blasser pressure
What is bladder exstrophy
Develpmental failure of the anterior bladder wall
Communication with the exterior
Effects of bladder exstrophy
Exposed bladder mucosa undergoes Colonic glandular metaplasia
Predisposes to infections and adenocarcinoma
Important details about urachal cysts
Persistent urachus with development of cysts lined by either transitional or metaplastic epithelium
Carcinoma may arise –> Colonic adenocarcinoma
Stages of the effects of bladder obstruction
- Hypertrophy of Smooth Muscle
- Muscle bundles become enlarged –> Trabeculation of bladder wall
- Crypts form –> Diverticula
What is malacoplakia?
A pattern of bladder inflammation characterized macroscopically by soft yellow slightly raised plaques
malacoplakia is comprised of…
Large, Foamy Macrophages
Multinucleate Giant Cells, Interspersed lymphocytes
Mps w/ granular cytoplasm, periodic acid-shiff positive, phagosomes full of bacterial debris
name the unique cellular structure in malacoplakia
Michelis-Gutmann bodies
Laminated, mineralized concretions
What is interstitial cystitis
- Persistent, Painful chronic cystitis in women assocaited with inflammation and fibrosis of all bladder wall layers.
- Intermittent, severe suprapubic pain, urinary frequency
- Autoimmune
What happens in Cystitis glandularis/cystica
Brunn lesions grow inward toward lamina propria
Central epithelial cell transform into cuboidal/columnar lining slitlike spaces or cysts.
Important details on hemorrhagic cystitis
Associated with radiation injury or chemotherapy
Nonspecific diffuse inflammation with hemorrhage
Three reasons women have more UTIs (acute cystitis)
Shorter Urethra
No Prostatic Fluids
Honeymoon Cystitis
Schistosomiasis is associated with development of…
Squamous Cell Carcinoma
Urinary symptoms associated with fever. Should you think kidneys or lower?
Kidneys
Fever can happen, but rare in lower
IMportant details to remember about Chronic Cystitis
Usually associated w/ obstruction
Heaping up of epithelium w/ red, friable, granular surface
Fibrous thickening of bladder wall
Follicular cystitis is characterized by aggregates of lymphocytes into follices
Etiology and Pathogenesis of Transitional Cell Carcinoma
Genetic alterations occur throughout mucosa, multicentric tumors.
Low Grade – Loss of 9p and 9q
High Grade – Loss of 17p w/ p53 loss
Who gets Transitional Cell Carcinoma
Mostly males, age 50-80
More common in industrialized, urban
Patients with risk factors
Risk factors for Transitional Cell Carcinoma
Cigarette Smoking napthylamine and analine dyes Long term analgesic use Cyclophosphamide Schistasoma
Important informatiton on Transitional Cell Carcinoma grading
Low grade always papillary, limited pleomorphism
High grade can be papillary or nodular, are very pleomorphic, and are 60% lethal in 10 years
Clinical course of Transitional Cell Carcinoma
PAINLESS HEMATURIA
Obstruction associated with hydronephrosis/pyelo
Tumors usually recur
Important details on squamous cell carcinoma of the bladder
Chronic Irritation/Infection, esp. w/ shistosoma
Most aggressive/Lethal form
Usually outside US
Important details on mesenchymal tumors of the bladder
Rare leiomyoma and sarcoma
Important details on secondary tumors of the bladder
Cervix, Uterus, Prostate, and Rectum
Hemorrhage, Obstruction, Fistulas
Important details on adenocarcinoma of the bladder
Urachal remnants
Intestinal metaplasia
Look like colonic or signet-ring carcinomas
Common causes of urethritis
Gonococcal, Chlamydia, Mycoplasma (ureaplasma urealyticum)
Enteric when associated with blockage
What is a urethral caruncle
Small, red, painful mass about the external urethral meatus in women. It is made of fibroelastic connective tissue, more or less heavily infiltrated with leukocytes
Tumors of the urethra?
Papillomas
Squamous Cell Carcinomas
Papillary transitional cell carcinoma (More aggressive than in bladder, shows up in older women near external meatus or surrounding strictures)
Malacoplakia is especially associated with infection with which organism
Proteus
