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PATH: Lower Urinary Tract Flashcards

1
Q

List some intrinsic causes of ureter obstruction.

A
  • Stones
  • Strictures
  • Neoplasms
  • Blood clots
  • Neurogenic causes
  • Vesicoureteral reflux
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2
Q

List some extrinsic causes of ureter obstruciton.

A
  • Pregnancy
  • Periureteral inflammation
  • Sclerosing retroperitoneal fibrosis
  • Endometriosis
  • Neoplasms
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3
Q

When you see “urinary stasis” what should you automatically think of?

A

INFECTION (static urine provides a rich culture medium)

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4
Q

How does ureter obstruction lead to hydronephrosis?

A

If long-standing interruption of normal outflow of urine from renal pelvis, the pelvis distends and increases pressure on the parenchyma of the kidney

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5
Q

List the causes of periureteral inflammation.

A

1) Salpingitis
2) Diverticulitis
3) Peritonitis

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6
Q

What is a fibrous proliferative inflammatory process that can encase retroperitoneal structures (including the ureter)?

A

sclerosing retroperitoneal fibrosis

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7
Q

Who gets sclerosing retroperitoneal fibrosis?

A

rare; middle to late age

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8
Q

70% of sclerosing retroperitoneal fibrosis is caused by what?

A

trick question (no obvious cause in 70%)

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9
Q

What are the identifiable causes of sclerosing retroperitoneal fibrosis?

A

Drugs
Crohn’s disease
malignant disease

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10
Q

What is the pathogenesis underlying ureteritis follicularis?

A

accumulation of lymphocytes in the subepithelial region of the ureter in chronic ureteritis may produce fine granularity of the mucosa

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11
Q

What is it called when the ureters have little 1-5 mm cysts filled with clear yellow fluid?

A

ureteritis cystica

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12
Q

What causes ureteritis?

A

UTIs

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13
Q

Who gets ureteropelvic junction obstruction?

A

infants or children (more common in boys, more common on the left)

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14
Q

What is the consequence of ureteropelvic junction obstruction?

A

hydronephrosis

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15
Q

What is the word for saccular outpouchings of the ureteral wall?

A

diverticula

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16
Q

How might you acquire a diverticula?

A

increased pressure secondary to obstruciton of urine outflow

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17
Q

What complication would you expect with a diverticula?

A

urinary stasis–> infection

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18
Q

What are some things that might obstruct the bladder?

A

1) enlarged prostate
2) cystocele of bladder
3) strictures of urethra
4) bladder tumors
5) post inflammatory fibrosis/contraction of bladder after cystitis
6) secondary invasion of bladder neck by growths
7) calculi
8) neurogenic bladder (injury to innervation)

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19
Q

What is characteristic finding of a bladder that has been exposed to chronic obstruction?

A

trabeculation of the bladder wall

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20
Q

What is the name for a developmental defect of closure of the anterior wall of the abdomen and the bladder so that the bladder communicates with the exterior of the body through a large defect or as an open sac?

A

exstrophy of the bladder

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21
Q

What is a possible complication of bladder exstrophy?

A

increased incidence of adenocarcinoma

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22
Q

What is the name for a vestigial structure between the apex of the bladder and the umbilicus?

A

urachus

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23
Q

What was the original role of the urachus?

A

connected bladder with allantois

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24
Q

What might be a complication of a uracheal cyst?

A

provide spot for adenocarcinomas to arise

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25
What might be a complication of a sequestered umbilical epithelial rest or bladder diverticulum?
infection
26
What is a cystocele?
protrusion of the bladder into the vagina (creating a pouch)
27
What leads to a cystocele?
uterine prolapse from loss of pelvic support
28
What feature of the intramural segment of the ureteral orifice permits the enclosing bladder musculature to act like a sphincter?
the oblique angled course (entry angle) of the ureter into the bladder)
29
What does a defect in the intravesicle portion of the ureter lead to?
vesicoureteral reflux
30
What are the common causes of acute cystitis?
E coli (MAJOR) Proteus Klebsiella Enterobacter
31
What are some non-infectious causes of acute cystitis?
cytotoxic anti-tumor drugs radiaton trauma
32
What are the symptoms of cystitis?
``` urinary frequency lower abdominal pain dysuria +/- fever chills malaise ```
33
What is in the inflammatory exudate of acute cystitis?
neutrophils
34
What is in the inflammatory exudate of chronic cystitis?
lymphocytes, plasma cells, and macrophages
35
What is follicular cystitis?
in chronic cystitis when lymphocytes form lymphoid follicles within the bladder mucosa and submucosa
36
In what condition can you develop a Hunner Ulcer?
Interstitial Cystitis
37
Who gets interstitial cystitis?
middle aged women
38
What are the symptoms of interstitial cystitis?
INERMITTENT, often severe suprapubic pain, urinary freuqency, urgency, hematuria and dysuria (w/o evidence of infection)
39
What is the cause of malakoplakia?
defective host response to a bacteria (usually GN bacilli) infection
40
What is the characteristic microscopic finding of malakoplakia?
Michaelis-Gutmann bodies (laminated mineralized concretions within and between macrophages)
41
What are contianed with macrophages/giant cells of malakoplakia?
PAS+ granules filled with bacterial debris
42
What are the "nests" that develop due to chronic cystitis that grow down into the LP?
Brunn nests
43
What happens to Brunn nests in the LP?
may undergo glandular metaplasia (cystitis glandularis) | OR retract to produce cystic spaces lined by flattened urothelium (cystitis cystica)
44
What complication of chronic cystitis may predispose to adenocarcinoma of the bladder?
cystitis glandularis
45
What is more common, epithelial or mesenchymal bladder cancer?
EPITHELIAL (95%) and of these 90% are transitional cell (urotehlial)
46
What are the two morphological patterns of urothelial tumors
papillary and flat
47
What is the classic patient who gets bladder cancer?
50-80 yo male SMOKER
48
True or false: many bladder tumors are multifocal at presentaiton.
TRUE
49
What mutation is typically found in non-invasive low-grade papillary carcinoma?
gain-of-function mutaitons in FGFR3
50
What mutation is typically found in high-grade and muscle invasive tumors (papillary or flat)?
Loss-of-function in TP53 and RB tumor supressor genes
51
What mutation is commonly seen in low-grade non-invasive papillary (papillomas) or flat (CIS) carcinomas?
activating mutaiton in HRAS oncogene
52
Do papillomas typically have both HRAS oncogene activation and FGFR3 activations?
NO--generally mutually exclusive
53
What is probably the earliest mutation seen in low-grade non-invasive papillary (papillomas) or flat (CIS) carcinomas?
losses of genetic material on chromosome 9
54
What are the two major genes that are lost with chromosome 9 deletions?
CDKN2A (9p) | PTCH (9q)
55
Loss of CDKN2A has what effect?
loss of p16/INK4a and ARF (protein that augments p53 function)
56
Loss of PTCH has what effect?
lack of negative regulation of the Hedgehog signaling pathway (no TSC1 to negatively regulate mTOR signaling)
57
What is the "less aggressive" pathway for bladder carcinogenesis?
FGFR3 and RAS mutations + chromosome 9 deletions--> lead to low-grade superficial papillary tumors--> minority may lose TP53 or RB funciton--> invade
58
What is the "more aggressive" pathway for bladder carcinogenesis?
TP53 mutations inititate noninvasive high-grade flat or papillary lesions--> loss of chromosome 9 + other mutations --> progression to invasion
59
What is the classic presentation of urothelial carcinoma of the bladder?
painless hematuria (may have increased frequency, urgency and dysuria too)
60
True or false: most bladder cancers are low grade lesions.
FALSE
61
Where do most bladder cancers arise?
lateral or posterior walls of the bladder base
62
Do all bladder carcinomas spread hematogenously?
no, only highly anaplastic tumors
63
What does a papilloma look like?
finger-like papillae with a central core of loose fibrovascular tissue covered by transitional epithelial cells
64
What patients are candidates for a radical cystectomy?
1) Tumor invading muscularis propria 2) CIS or high-grade papillary cancer refractory to BCG 3) CIS extending into the prostatic urethra and prostatic ducts (where BCG cannot reach it)
65
How is the prognosis of bladder cancer unique?
tumor grade determines more of the prognosis
66
True or false: the higher the grade of urothelial tumor, the higher the chance of recurrence.
true!
67
Squamous cell carcinoma of the bladder is associated with what?
``` Schistosomiasis (Egyptian males) Chronic irritation (caculi) ```
68
Why does squamous cell carcinoma have a worse prognosis than urothelial?
higher stage at presentation
69
If you see adenocarcinoma of the bladder, what should you think of?
urachal remnant or exstrophy (VERY RARE)
70
What are the 2 types of sarcoma that may be in the bladder?
Rhabdomyosarcoma | Leiomyosarcoma
71
What are the divisions of urethritis?
gonoccocal | non-gonococcal (E. coli, chlamydia, etc.)
72
What disease (arthritis and conjunctivitis) has urethritis associated with it?
Reiter syndrome
73
What is the name of the inflammatory lesion presenting as a small, red, painful friable mass about the external urethral meatus in the female patient?
urethral caruncle
74
What is the most common type of urethral carcinoma
squamous cell carcinoma
75
Who gets carcinoma of the urethra?
rare; older women
76
What is epidspadias?
abnormal opening of urethera on dorsal side of the penis
77
What is hypospadias?
abnormal opening of urethera on ventral side of the penis
78
Which is more common, hypospadias or epidspadias?
hypospadias
79
What is the name of the inability to easily retract the foreskin of the penis?
phimosis
80
What is the complicaiton of phimosis?
accumulation of secretions under the prepuce which leads to inflammation (blaanoposthitis= posthitis)
81
What is the cause of phimosis?
poor hygeine
82
What would you call squamous cell carcinoma on the shaft of the penis?
Bowen disease
83
What ould you call squamous cell carcinoma on the glans of the penis?
erythroplasia of Queyrat
84
What are 80% of squamous cell carcinomas of the penis related to?
HPV (usually type 16)
85
True or false: almost all squamous cell carcinomas occur in men who are circumcised.
FALSE: almost all in uncircumcised males

Reproductive (21 decks)

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