Quiz 4 Flashcards
Patients with single upper tract lesion are at risk of developing bladder carcinoma, the converse is also true?
False
- those with bladder cancer are NOT at increased risk of upper tract lesion
ureteral and renal pelvic cancers have been linked to the following etiologies:
smoking
contrast/industrial dyes
NSAID use
BALKAN NEPHROPATHY - along Danube river
Most ureteral (97%) and renal pelvic cancers are . what type?
TCC
Patient presents with
gross hematuria
MB flank pain due to ureteral obs and irritative voiding symptoms
You assess them and see an increase in LFTs
- what are you looking at?
Ureteral and Renal Pelvic cancer
- cytology will be positive
What is the most common congenital anomaly of the ureter?
Obstruction of the Ureteropelvic Junction
leads to
- hydronephrosis
- stones
- hematuria
- UTI
- HTN
this is due to one or both ureters becoming compressed by chronic inflammation in the retroperitoneal tissues - caused by malignant disease, commonly BREAST cancer, Hodgkin’s dz and colon CA. It presents with non-specific symptomology - things like back pn, malaise, anorexia, wt loss and if severe, uremia - what is this?
Retroperitoneal fibrosis
- acquired anomaly of the ureter
this is common in post-menopausal women, it’s often misdiagnosed as a caruncle - what is this? and why does it occur?
senile urethritis
- Low E can cause retrogressive (senile) changes in the vaginal mucosa
- eversion of mucosa around urethral orifice
this is rare, but will present with slight bleeding on the underwear, generally post-menopausal. When examined - you’ll see benign, red raspberry like, friable vascular tumor that involves the posterior lip of the ext. meatus - what condition is this?
urethral caruncle
- dysuria
- dyspareunia
- bloody spotting
BX
this is relatively common in men - they present with decreased urinary stream, spraying, double stream, post-void dribbling - caused by external trauma and or catheterization - what is it?
male urethral stricture
ACQUIRED
it’s a fibrotic narrowing of the urethral that is composed of dense collagen and fibroblasts - restricts urine flow and causes dilation of the proximal urethra and prostatic ducts
if a patient presents with
- flank pain, lower abd or testes/labial pn
with potential concomintant sx of
N/V, abd mass, urgency, frequency and polyuria - what would you suspect?
hydronephrosis
- may have HTN from increased renin
Order US
What is newer terminology for Peyronie’s Dz?
CITA
Chronic Inflammation of the Tunica Albuginea
up to 10% of men with ED have what?
Peyronie’s disease
- plaque on dorsal surface of penis
r/o other causes of:
- smoking
- hyperlipidemia
- HTN
- DM
patient comes in complaining of penile pain with erection - what is at the top of your differential?
Peyronie’s disease
- wound healing disorder leads to scarring of tunica albiginea
this is a condition where the foreskin cannot be retracted back from the glans penis -
phimosis
- do not force retraction
this is a condition where the foreskin is stuck in the retracted position which could lead to reduced blood flow to the glands and maybe necrosis
paraphimosis
this is a term for:
inflammation of the glans penis
balanitis
this is a term for:
inflammation of the foreskin
posthitis
this is a term for:
inflammation of both the glans penis and the foreskin
balanoposthitis
- could happen from poor hygiene
what is a cause of pathological phimosis and who is found to have it most commonly?
balanitis xerotica obliterans (BX)
MC found in middle-aged diabetics
- increased incidence in African American and Hispanic men
what percentage of men are circumcised worldwide?
30%
- men who ARE circumcised have almost zero incidence of penile cancer
- men who are NOT, 2.2/100,000 rate of cancer
What strain of HPV is linked to penile cancer?
16
This condition may cause bloody spotting from the urethra in men - examination may show protruding papilloma
condylomata acuminata
these occur in up to 30% of men, 1-2mm fleshy or white, dome-shaped papules that arrange themselves circumferentially at the corona - sometimes they are densely packed in several rows - what are these?
pearly penile papules
Most penile cancers are what?
invasive carcinoma of the penis
- typically originates in the glans
what are the three precancerous lesions we need to be aware of?
- leukoplakia - RARE - red, irritated, sore
- balanitis xerotica obliterans - white patch on prepuse or glans
- giant condylomata acuminata - cauliflower-like lesion on prepuce, glans or shaft
what are the two carcinoma in situ to be aware of?
Bowen Disease - red plaque with encrustations
Erythroplasia of Queyrat - VELVETY RED lesions with ulcerations - gen on glans
What nodes do the prepuce and shaft skin drain to?
superficial inguinal nodes
what nodes do the glans and corporal bodies drain to?
superficial and deep inguinal nodes
Where do the inguinal nodes drain?
pelvic nodes
Although rare (10% of cases) - where would penile cancer mets to?
lung
liver
brain
what are the I-IV tumor stages for the penis?
I - glans
II - shaft
III - penis and nodes
IV - mets
how do you dx penile cancer?
biopsy is mandatory
what is the prognosis for no-nodal involvement in penile cancer?
65-90% 5-year survival
20-50% 5yr for positive inguinal nodes*
Early detection is key and up to 50% of men delay x 1 year before seeking treatment
