Male Genital Tract I Flashcards
What is the clinical significance of ureter abnormalities?
Ureter abnormalities can lead to reflux (backwash) which can lead to inflammation and pyelonephritis
What is the most common cause of hydronephrosis in children?
Ureteropelvic junction obstruction (UPJ)
What is bladder exstrophy?
developmental failure in the anterior wall of the abdomen - does not enclose the bladder
List predisposing factors to cystitis
bladder calculi, urinary obstruction, diabetes mellitus, instrumentation, immune deficiency
What is interstitial cystitis?
Chronic pelvic pain syndrome- persistent, painful, non-bacterial form of cystitis
Who gets chronic cystitis?
90% female (age 30-50)
What is the clinical presentation of chronic cystitis?
Intermittent, often severe suprapubic pain, urinary frequency, urgency, hematuria, dysuria
Chronic cystitis is associated with which other diseases?
Allergies and autoimmune diseases
What is the MOA of malakoplakia?
Defects in phagocytic or degradative function of macrophages
What are the gross findings of malakoplakia in the bladder?
multiple raised, soft, yellow to brown plaques and nodules
What are Michaelis-Gutman bodies?
Blue, targetoid calcospherules - found in malakoplakia
Does malakoplakia lead to malignancy?
No
What leads to squamous metaplasia/ leukoplakia?
Long term irritation or chronic infection
Stones, non-functioning bladders, schistosomiasis
What is the clinical significance of squamous metaplasia/leukoplakia?
If extensive, it can interfere with contraction and dilatation.
There is an increased risk for carcinoma
What is bladder cancer so expensive to treat?
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
What is the clinical presentation of bladder cancer?
Painless hematuria- 80%
What are common etiologies for bladder cancer?
SMOKING Arylamines Chronic cystitis Cylcophosphamide Long term analgesic use (phenacetin) Pelvic irradiation
What are the two pathways for invasion in bladder cancer?
Papillary and flat
80% are papillary
What are the genetics of the papillary pathway of carcinoma?
Genetically stable- 85% have FGFR3 mutations
What are the genetics of the non-papillary pathways of carcinoma?
Genetically instable- with p53 mutations
What is the prognosis for urothelial papillomas?
They are completely benign
What is the prognosis for high grade urothelial carcinoma?
Local recurrence 36-60%
40-60% will progress to invasive carcinoma
15% mortality
What is the role of BCG vaccinations and urothelial cancer?
The vaccine elicits a local cell-mediated immune reaction that destroys tumor cells. It is designed to treat current disease and prevent recurrence
What is the most common bladder sarcoma in kids?
Embryonal rhabdomyosarcoma
What is the most common mesenchymal bladder tumor in adults?
Leiomyosarcoma
