Male Genital Tract I

Question 1

What is the clinical significance of ureter abnormalities?

Answer 1

Ureter abnormalities can lead to reflux (backwash) which can lead to inflammation and pyelonephritis

Question 2

What is the most common cause of hydronephrosis in children?

Answer 2

Ureteropelvic junction obstruction (UPJ)

Question 3

What is bladder exstrophy?

Answer 3

developmental failure in the anterior wall of the abdomen - does not enclose the bladder

Question 4

List predisposing factors to cystitis

Answer 4

bladder calculi, urinary obstruction, diabetes mellitus, instrumentation, immune deficiency

Question 5

What is interstitial cystitis?

Answer 5

Chronic pelvic pain syndrome- persistent, painful, non-bacterial form of cystitis

Question 6

Who gets chronic cystitis?

Answer 6

90% female (age 30-50)

Question 7

What is the clinical presentation of chronic cystitis?

Answer 7

Intermittent, often severe suprapubic pain, urinary frequency, urgency, hematuria, dysuria

Question 8

Chronic cystitis is associated with which other diseases?

Answer 8

Allergies and autoimmune diseases

Question 9

What is the MOA of malakoplakia?

Answer 9

Defects in phagocytic or degradative function of macrophages

Question 10

What are the gross findings of malakoplakia in the bladder?

Answer 10

multiple raised, soft, yellow to brown plaques and nodules

Question 11

What are Michaelis-Gutman bodies?

Answer 11

Blue, targetoid calcospherules - found in malakoplakia

Question 12

Does malakoplakia lead to malignancy?

Answer 12

No

Question 13

What leads to squamous metaplasia/ leukoplakia?

Answer 13

Long term irritation or chronic infection

Stones, non-functioning bladders, schistosomiasis

Question 14

What is the clinical significance of squamous metaplasia/leukoplakia?

Answer 14

If extensive, it can interfere with contraction and dilatation.

There is an increased risk for carcinoma

Question 15

What is bladder cancer so expensive to treat?

Answer 15

75% of cancers are superficial (therefore not deadly)

People who are diagnosed must come back every year for the rest of their life to monitor progression of the disease

Question 16

What is the clinical presentation of bladder cancer?

Answer 16

Painless hematuria- 80%

Question 17

What are common etiologies for bladder cancer?

Answer 17

SMOKING
Arylamines
Chronic cystitis
Cylcophosphamide
Long term analgesic use (phenacetin)
Pelvic irradiation

Question 18

What are the two pathways for invasion in bladder cancer?

Answer 18

Papillary and flat

80% are papillary

Question 19

What are the genetics of the papillary pathway of carcinoma?

Answer 19

Genetically stable- 85% have FGFR3 mutations

Question 20

What are the genetics of the non-papillary pathways of carcinoma?

Answer 20

Genetically instable- with p53 mutations

Question 21

What is the prognosis for urothelial papillomas?

Answer 21

They are completely benign

Question 22

What is the prognosis for high grade urothelial carcinoma?

Answer 22

Local recurrence 36-60%

40-60% will progress to invasive carcinoma
15% mortality

Question 23

What is the role of BCG vaccinations and urothelial cancer?

Answer 23

The vaccine elicits a local cell-mediated immune reaction that destroys tumor cells. It is designed to treat current disease and prevent recurrence

Question 24

What is the most common bladder sarcoma in kids?

Answer 24

Embryonal rhabdomyosarcoma

Question 25

What is the most common mesenchymal bladder tumor in adults?

Answer 25

Leiomyosarcoma