Pathology of the Lower Urinary Tract Flashcards
Vesicoureteric reflux
Failure of the bladder to empty properly
Most common in babies and young children
Can be unilateral or bilateral
Urine refluxes from bladder back up into kidney
Bacteria from bladder can reach the kidney
Can lead to kidney infection and kidney damage
Ureterocele complications
Larger ureteroceles can lead to more severe restriction of urine flow than smaller ones – more susceptible to UTIs, VUJ reflux, and hydronephrosis
UTIs can lead to kidney infections and kidney damage when reflux occurs
Can also get: Infected ureteroceles Calculi Thrombus TCC
Ectopic ureteric opening complications
Ureterocele
Reflux
Difficult to locate use colour Doppler to search for jet
Bladder diverticulum
Pouch/es that form in bladder wall
Congenital or acquired
Forms when bladder lining permeates through a weakness in the muscular bladder wall
Thickened bladder wall
Most commonly from inflammation and / or scarring
Inflamed bladder wall is called cystitis (see next)
Can appear thickened from beginnings of TCC
Ultrasound presentation:
Thickening of wall – can be diffuse or localised
Remember, bladder fullness is important when assessing bladder wall thickness
Cystitis
Inflamed bladder wall
Most common cause – UTI (infectious cystitis)
S&S: Frequency of urination Burning pain on urination Strong-smelling urine Pain lower abdo Haematuria Cloudy urine
Neurogenic bladder
Lack of bladder control caused by neurologic damage
Complications: UTIs Kidney stones Urinary incontinence Small urinary volume upon voiding Urinary frequency & urgency Urgency Urinary retention Loss of feeling that bladder is full
Ultrasound presentation:
Over-filled bladder (patient may not feel this)
Large residual volume
Calculi
AKA vesical calculi
Build up of minerals in urine
Incomplete bladder emptying
S&S:
None if stone is non-obstructive
Bladder neoplasms
Benign: Papilloma Inverted papilloma Leiomyoma Haemangioma Lipoma Neurofibroma
Malignant: Transitional cell carcinoma Squamous cell carcinoma Adenocarcinoma Sarcoma Small cell carcinoma Plasmacytoid carcinoma Micropapillary carcinoma
Can be both:
Bladder polyp
Papilloma
AKA Urothelial or transitional cell papillomas
Uncommon – 1-4% of bladder tumours
Most commonly found in bladder neck and trigone area
May arise as it is or as a secondary papilloma in patients with a Hx of bladder cancer
Clinical presentation:
Haematuria
Inverted papilloma
Uncommon
Most commonly found in bladder neck and trigone area
Clinical presentation:
Macroscopic haematuria
Dysuria
Bladder polyps
Growth arising from mucous membrane of bladder
Abnormal growth of cells – unknown aetiology
Can be benign or malignant
When growth is rapid and spreads, malignant
Clinical presentation: Haematuria Dysuria Incr frequency & urgency Pain
Transitional Cell Carcinoma (TCC)
AKA urothelial carcinoma
Most common bladder and lower UT cancer (ureter, urethra) – 80-95%
Clinical presentation:
Pain in back
Haematuria
Frequent urination
Squamous Cell Carcinoma (SCC)
Rare – 1-2%
Associated with chronic infection and irritation of the bladder wall (i.e. long term use of catheter, chronic UTIs)
Growth starts as a thin, flat layer within the epithelial tissue that lines the bladder
Likely to be invasive into bladder wall
Worst prognosis
Adenocarcinoma
Rare – 1% Most common in bladder exstrophy Growth begins within the glandular cells of the bladder Likely to be invasive into bladder wall Poor prognosis
