Pathology of urethral tract Flashcards
What epithelium lines the bladder?
Transitional epithelium
What can cause cystitis?
Infection
Parasites
Aseptic
Reactive to catheters
How does schistosomiasis infection lead to cancer?
Persistent inflammation
Results in keratinizing squamous metaplasia
Eventual squamous cell carcinoma
What can cause persistent inflammation in the bladder?
Schistosomiasis
In-dwelling catheters
What is aseptic cystitis?
Persistent symptoms of dysuria
Persistently negative cultures and urinalysis
Caused by a hypersensitivity reaction
What is cystitis cystica?
Descriptive term of long term inflammation
Infolding of bladder mucosa into cysts
Reactive phenomenon
What can can result for diverticula in the bladder?
Stagnant urine
Infection
Stones
Cancer
What will result from bladder obstruction outflow?
Prostatism
Bladder muscle works hard and becomes trabeculated
Eventual persistent back pressure
Can undergo hypertrophy or hyperplasia
What is the end point of urinary tract obstruction?
Hydronephrosis - dilation of collecting ducts and atrophic parenchyma
What are risk factors for transitional cell carcinoma of the bladder?
Smoking ++++
Beta naphthylamine in the dye industry
What does a transitional cell carcinoma look like?
Papillary with finger like projections
Carcinoma in situ is flat
What will allow adenocarcinoma of the bladder to occur?
Background of metaplasia
Difficult to distinguish from a colon cancer that has invaded through
What does urachal adenocarcinoma result from?
Remnant of the allantois
Forms dome of bladder to the umbilicus which usually involutes
What is the function of the prostate gland?
Secretes prostatic fluid and fluid from seminal vesicles
Contractile function during ejaculatioin
What part of the prostate gland does the seminal vesicle pass through?
Central zone
What part of the prostate does the urethra pass through?
Transitional zone (area for PBH)
What part of the prostate is prostate cancer most commonly found in?
Peripheral zone
How can BPH be treated?
Transurethral resection of prostate
Alpha blockers
How is prostate cancer diagnosed?
Transrectal biopsy
PSA
What grading system is used for prostate cancer?
Gleason grading system - lowest grade is 6, highest is 10
What can cause a high PSA?
Big prostate (BPH) Prostatitis PR exa Spironolactone Vigorous exercise Ejaculation
What is the clinical presentation of prostate cancer?
Lower urinary tract symptoms Haematuria/ hematospermia Bone pain Anorexia Wt loss
What will prostate cancer feel like upon PR exam?
Asymmetrical
Nodular
Fixed and craggy
What is PSA?
Glycoprotein enzyme produced by the secretory epithelial cells of the prostate gland
Involved in liquefaction of semen
What type of cancer affects the prostate?
Adenocarcinoma
Where does prostate cancer commonly spread to?
Pelvic lymph nodes
Skeleton - sclerotic lesions
What are the broad classifications of prostate cancer?
T1-2 N0 M0 = organ confined disease
T3-4 N0 M0 = locally advanced disease
N+ M+ = metastatic disease
What is the management for organ-confined disease?
Watchful waiting
Active surveillance
Radical surgery
Radical radiotheapy
What are complications of radical prostatectomy?
ED
Incontinence
Bladder neck stenosis
What is the treatment for locally advanced disease?
Radiotherapy with neoadjuvant hormonal therapy
What hormonal therapy is used in metastatic disease?
LHRH analogues
Anti-androgens
What is the growth of prostate cancer cells under the influence of?
Testosterone and dihydrotestosterone
What should you do if someone over 40 present with frank haematuria?
Flexible cystoscopy and CT urogram
Where will lymph from the ureter drain?
Lumbar and iliac nodes
Where will lymph from the testes drain?
Lumbar nodes
Where will lymph from the superior bladder drain to?
Lumbar nodes
Where will lymph from the kidneys drain to?
Para-aortic
Pre-aortic nodes
