Lower Urinary Tract Flashcards
What makes up the lower urinary tract?
Bladder and urethra
What are the ureters, bladder, and urethra lined with?
Transitional epithelium
What is the special name for the transitional epithelium found in the lower urinary tract?
Urothelium
What is the terminal portion of the urethra lined with?
Squamous epithelium
What is important to know about the lower urinary tract in females?
Ureters lie close to the uterine arteries and are vulnerable to injury in operations on the female genital tract
The close relationship of the female genital tract to the bladder makes possible the spread of disease from one tract to the other
What is the Lamina propria?
thin layer of smooth muscle of the bladder
What is the detrusor muscle?
Thick layer of smooth muscle of the bladder
What is the problem with congenital anomalies of the ureters?
They can contribute to obstruction of flow of urine and therefore cause recurrent urinary tract infections and pyelonephritis
What is a Bifid Ureter?
Congenital anomaly ONLY
Associated with some kidney anomaly also
Two ureters can join together or reach bladder as two extra ureters
Only time it causes an issue is if there is a kidney problem already in the patient
What is the Ureteropelvic (UP) Junction Obstruction the most common cause of?
Hydronephrosis in infants and children
What is Diverticula?
Outpouching of ureters that are usually asymptomatic
What is a hydroureter?
The complete dilation, elongation, and tortuosity of a ureter
Normal finding in pregnancyf
What type of anomaly are UP Junction Obstruction and Diverticula?
Congenital or acquired anomalies
What can preceed pyelonephritis?
Cystitis
What are the common agents that cause Cystitis?
E. coli
Proteus
Klebsiella
Enterobacter
Who are more likely to develop cystitis and why?
Women because they are shorter urethras
What are the predisposing factors for Cystitis?
Diabetes Mellitus
Instrumentation like catheterization
Immune Deficiency
What are the triad of symptoms that occur with Cystitis/
Increased Frequency of urination
Lower abdominal pain
Dysuria
What is cystitis a secondary complication of?
Any underlying disorder associated with urinary stasis:
Prostatic Enlargment
Cystocele of the bladder
Calculi
Tumors
What are urothelial tumors?
Small benign lesions to aggressive fatal cancers
Where do Urothelial Tumors most common?
In the bladder but can be seen at any site where there is urothelium, from the renal pelvis to the distal urethra
Who is urothelial tumors most common in?
Higher in men than women
50-80 years of age
What is the percentage of bladder cancer and cancer mortality in the US?
7% cancers
3% cancer mortality
Is bladder cancer familial?
No
What is the most common cause of bladder cancer?
Cigarette Smoking
What are the causes of bladder cancer?
Smoking Chemical carcinogens like aryl amines Long term exposure to analgesics Heavy long-term exposure to cyclophosphamide Irradiation
What is the most common symptom of bladder cancer?
Painless hematuria
What are the symptoms of bladder cancer?
Painless Hematuria
Frequency
Urgency
Dysuria
What do urothelial tumors have the tendency to do?
They develop new tumors after excision
What does the prognosis of bladder cancer depend on?
Histologic grade and stage of diagnosis
What is the clinical challenge of bladder cancer?
Early detection and adequate follow-up
What does bladder cancer first present as?
Pyelonephritis
Hydronephrosis
What are the four morphologic patterns of bladder cancer?
Papilloma
Invasive Papillary Carcinoma
Flat-noninvasive carcinoma
Flat invasive carcinoma
What is Urethritis commonly associated with?
STDs
What are the two types of Urethritis?
Gonococcal
Non-Gonoccal
What STD is associated with Gonococcal urethritis?
Neisseria gonorrhea
What STDs are associated with Non-Gonococcal urethritis?
Chlamydia
Mycoplasma
What are the symptoms associated with Urethritis?
Local pain
Itching
Frequency
May warn of more serious disease at higher levels of the urogenital tract
