Lower Urinary Tract Path (Handorf) Flashcards
What are the layers of the wall of the ureter?
mucosa, muscualris, and adventitia
what propels the urine through the ureter?
peristaltic contractions
aquired strictures in the ureter are due to ..
chronic inflammation or sclerosing retroperitoneal fibrosis
what are the most common tumors in the ureter
mets
what are the most common benign primary tumors of the ureter?
fibroepithelial polyps and leiomyomas
what is the most common type of malignant tumor of the ureter?
transitional cell carcinoma
intrinsic or extrinsic cause of ureter obstruction:
neurogenic causes
intrinsic (interruption of neuronal pathways)
what is a the major/serious complication of chronic ureter obstruction?
hydronephrosis (which can lead to renal failure)
**due to distention of renal pelvis and increased pressure on the kidney parenchyma
What are causes of periureteral inflammation
salpingitis, diverticulitis, peritonitis, sclerosing retroperitoneal fibrosis
a fibrous proliferative inflammatory process thet encases retroperitoneal structures and causes compression of the ureter
sclerosing retroperitoneal fibrosis
what are the causes of sclerosing retroperitoneal fibrosis
unknown (70%)
drugs
chron’s dz
malignancy (lymphoma and urinary tract carcinoma)
ectopic endometrium is…
endometriosis
is the endometrial tissue in endometriosis functional?
yes
how can endometriosis lead to ureter obstruction?
hormones –> proliferation –> bleeding –> scarring –> compression of uretrer
what are 2 outcomes of chronic ureteritis
ureteritis folliculitis and ureteritis cystica
gross difference between ureteritis folliculitis and ureteritis cystica
ureteritis folliculitis = fine granularity on mucosal surface
ureteritis cystica = cysts on mucosal surface
produced by the accumulation of lymphocytes in the subepithelial region of the ureter in response to chronic inflammation
ureteritis folliculitis
male infant with hydronephrosis on the left side
uteropelvic junction obstruction
what is the pathophys of uteropelvic junction obstruction
abnormal organization and/or excess STROMAL deposition of COLLAGEN between smooth muscle bundles
saccular outpouchings of ureteral wall
diverticula
etiology of diverticula
congenital or due to increased pressure secondary to obstruction
what is the complication most assc with diverticula?
pockets of stasis = infection
congenital anomalies of the ureter
double/bifricated ureters, uteropelvic junction obstruction
describe the changes that occur in the bladder with chronic obstruction
increased pressure → hypertrophy → trabeculation → crypts form → diverticula → pyelonephritis or hydronephrosis
congenital cause of bladder diverticuIi
focal muscular defect
most common aquired cause of bladder diverticuIi
urethral obstruction
developmental defect of the closure of the anterior wall of the abdomen and the bladder
exstrophy
*i.e. the bladder communicates with the exterior of the body
vestigial structure that located between the apex of the bladder and the umbilicus and connected the bladder to the allantois
urachus
result of a totally patent urachus
fistulous urinary tract
result of a urachus with only the center obliterated
diverticulum (infections)
result of a urachus with only the center persists
urachal cyst –> adenocarcinoma
describe the pathogenesis of a cystocele
relaxation of the pelvic support (usually old age/trauma from childbirth) → uterine prolapse → bladder floor pulled downward into vagina = cystocele
congenital cause of vesicoureteral reflux
defect in the intravesical portion of the ureter such that there is no longer an oblique connection
**without the oblique connection the bladder musculature cannot act like a sphincter
how does vesicoureteral reflux present?
baby with lots of UTIs, pylonephrosis, or hydronephrosis
orgs that commonly cause cystitis
E coli, proteus, klebsiella, enterobacter
**presents like a UTI
seen in exudate of acute cystitis
neutrophils
*these predominate
seen in the exudate of chronic cystitis
lymphocytes, plasma cells, macrophages
*these predominate
non-infectious cuases of cystitis
radiation, chemo, trauma
lymphoid follicles are formed in the bladder mucosa in …
follicular cystitis (a form of chronic cystitis)
foamy macropahges (PAS +) and michaelis-gutmann bodies
malakoplakia
what is the etiology/pathogenesis of malakoplakia
defective host response to bacterial infection
middle aged woman
suprapubic pain, uirnary frequency, urgency, and hematuria, without evidence of bacterial infection
interstitial cystitis
related to cystitis cystica and is due to chronic inflammation of the bladder
cystitis glandularis
90% of bladder tumors originate from
urothelium (transitional epithelium)
inflammation and fibrosis of all layers of the bladder wall +/- localized mucosal ulcers (Hunner ulcers)
interstitial cystitis
may predispose people to adenocarcinom
cystitis glandularis
exstrophy
urachal remnant
morphologic patterns of urothelial bladder tumors
papillary and flat
what areas of the bladder do most cancers arise? consequence of this?
lateral and posterior walls at the base –> commonly causes ureteral obstruction
risk factors for bladder carcinomas
aniline dyes smoking cylophosphamide phenacetin schistosomiasis
presenting symptoms of bladder carcinoma
painless hematuria
+/- frequency, urgency and dysruia
where do bladder carcinomas invade?
bladder wall, prostate, seminal vesicles, ureters, retroperitoneum,
**may produce fistuals to the vagina or rectum
where do bladder carcinomas metastasize to?
regional LN, liver, lungs, bone marrow
*heme spread
what tends to happen to urothelial tumors after they are removed?
new ones develop and these are typically at a higher grade
in general, the higher the grade of the urothelial tumor, the
higher the chance of reoccurance
assc with schistosomiasis and chronic irriation (i.e. calculi)
squamous cell carcinoma of the bladder
where to squamous cell carcinomas of the bladder tend to airse?
trigone
what morphology do squamous cell carcinomas of the bladder commonly have
fungating and invasive
focal glandualr changes with mucin production
adenocarcimona
adenocarcimona common morphology
solitary and deeply invasive (may ulcerate in center)
non-smoker, egyption immigrant with bladder cancer most likely has
squamous cell carcinomas of the bladder
benign bladder neoplasms
leiomyoma
hemangioma
granular cell tumor
neurofibroma
schistosoma hematobium
squamous cell carcinomas of the bladder
malignant mesenchymal bladder neoplasms
rhabdomyosarcoma
leiomyosarcoma
**sarcomas
grape like projections into lumen of bladder in an infant or child
embryonal rhabdomyosarcoma (sarcoma botryoides)
arthritis + conjunctivitis + urethritis
reiter syndrome
structure of the urethra is due to … and causes…
due to chronic urethritis and can cause outflow obstruction
small, red, painful, friable mass about the external urethral meatus in a female pt
urethral caruncle
histo of urethral caruncle
leukocytes + fibrous CT (vascularized)
tumor at the external meatus of the urethra and has a viral origin
papilloma
____ carcinomas occur in the urethra (typically at the external meatus)
squamous cell
