Lower Urinary Tract

Question 1

What is cystocele

Answer 1

Protrusion of bladder into the vagina

Question 2

What happens in a ureteropelvic junction obstruction

Answer 2

Abnormal organization of small muscle bundles or excess stromal deposits. Associated with agenesis of opposite kidney

Question 3

Chronic inflammation of the ureter can lead to…

Answer 3

ureteritis follicularis – Fine granular mucosal changes w/ lympho. aggregates
ureteritis cystica – fine cysts develop in the ureter walls

Question 4

Name for benign tumors of the ureter

Answer 4

Fibroepithelial polyps

Question 5

Explain sclerosing retroperitoneal fibrosis

Answer 5

• Fibrous proliferative inflammatory process encasing the retroperitoneal structures.
• Autoimmine, Drug Triggered
• Prominent lymphocytic infiltrate w/ germinal centers and plasma cells

Question 6

Causes of bladder diverticula

Answer 6

• Congenital focal failure of normal musculature

- Longstanding increase in blasser pressure

Question 7

What is bladder exstrophy

Answer 7

Develpmental failure of the anterior bladder wall

Communication with the exterior

Question 8

Effects of bladder exstrophy

Answer 8

Exposed bladder mucosa undergoes Colonic glandular metaplasia
Predisposes to infections and adenocarcinoma

Question 9

Important details about urachal cysts

Answer 9

Persistent urachus with development of cysts lined by either transitional or metaplastic epithelium
Carcinoma may arise –> Colonic adenocarcinoma

Question 10

Stages of the effects of bladder obstruction

Answer 10

1. Hypertrophy of Smooth Muscle
2. Muscle bundles become enlarged –> Trabeculation of bladder wall
3. Crypts form –> Diverticula

Question 11

What is malacoplakia?

Answer 11

A pattern of bladder inflammation characterized macroscopically by soft yellow slightly raised plaques

Question 12

malacoplakia is comprised of…

Answer 12

Large, Foamy Macrophages
Multinucleate Giant Cells, Interspersed lymphocytes
Mps w/ granular cytoplasm, periodic acid-shiff positive, phagosomes full of bacterial debris

Question 13

name the unique cellular structure in malacoplakia

Answer 13

Michelis-Gutmann bodies

Laminated, mineralized concretions

Question 14

What is interstitial cystitis

Answer 14

• Persistent, Painful chronic cystitis in women assocaited with inflammation and fibrosis of all bladder wall layers.
• Intermittent, severe suprapubic pain, urinary frequency
• Autoimmune

Question 15

What happens in Cystitis glandularis/cystica

Answer 15

Brunn lesions grow inward toward lamina propria

Central epithelial cell transform into cuboidal/columnar lining slitlike spaces or cysts.

Question 16

Important details on hemorrhagic cystitis

Answer 16

Associated with radiation injury or chemotherapy

Nonspecific diffuse inflammation with hemorrhage

Question 17

Three reasons women have more UTIs (acute cystitis)

Answer 17

Shorter Urethra
No Prostatic Fluids
Honeymoon Cystitis

Question 18

Schistosomiasis is associated with development of…

Answer 18

Squamous Cell Carcinoma

Question 19

Urinary symptoms associated with fever. Should you think kidneys or lower?

Answer 19

Kidneys

Fever can happen, but rare in lower

Question 20

IMportant details to remember about Chronic Cystitis

Answer 20

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

Question 21

Etiology and Pathogenesis of Transitional Cell Carcinoma

Answer 21

Genetic alterations occur throughout mucosa, multicentric tumors.
Low Grade – Loss of 9p and 9q
High Grade – Loss of 17p w/ p53 loss

Question 22

Who gets Transitional Cell Carcinoma

Answer 22

Mostly males, age 50-80
More common in industrialized, urban
Patients with risk factors

Question 23

Risk factors for Transitional Cell Carcinoma

Answer 23

Cigarette Smoking
napthylamine and analine dyes
Long term analgesic use
Cyclophosphamide
Schistasoma

Question 24

Important informatiton on Transitional Cell Carcinoma grading

Answer 24

Low grade always papillary, limited pleomorphism

High grade can be papillary or nodular, are very pleomorphic, and are 60% lethal in 10 years

Question 25

Clinical course of Transitional Cell Carcinoma

Answer 25

PAINLESS HEMATURIA
Obstruction associated with hydronephrosis/pyelo
Tumors usually recur

Question 26

Important details on squamous cell carcinoma of the bladder

Answer 26

Chronic Irritation/Infection, esp. w/ shistosoma
Most aggressive/Lethal form
Usually outside US

Question 27

Important details on mesenchymal tumors of the bladder

Answer 27

Rare leiomyoma and sarcoma

Question 28

Important details on secondary tumors of the bladder

Answer 28

Cervix, Uterus, Prostate, and Rectum

Hemorrhage, Obstruction, Fistulas

Question 29

Important details on adenocarcinoma of the bladder

Answer 29

Urachal remnants
Intestinal metaplasia
Look like colonic or signet-ring carcinomas

Question 30

Common causes of urethritis

Answer 30

Gonococcal, Chlamydia, Mycoplasma (ureaplasma urealyticum)

Enteric when associated with blockage

Question 31

What is a urethral caruncle

Answer 31

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

Question 32

Tumors of the urethra?

Answer 32

Papillomas
Squamous Cell Carcinomas
Papillary transitional cell carcinoma (More aggressive than in bladder, shows up in older women near external meatus or surrounding strictures)

Question 33

Malacoplakia is especially associated with infection with which organism

Answer 33

Proteus