Robbins Ch. 21 - Lower UT and Male Genital System I

Question 1

muscularis propriae

Answer 1

muscle bundles of detrusor muscle

-bladder cancers that invade this layer are staged differnetly

Question 2

urine flow obstructed

Answer 2

bladder musculature hypertopy

Question 3

operations of female genital tract

Answer 3

ureters lie close to uterine arteries

-vulnerable to injury

Question 4

narrowing of the ureter

Answer 4

ureteropelvic junction
where enter bladder
cross iliac vessels

-all locations where calculi may cause blockage

Question 5

prolapse of uterus

Answer 5

descent - pulls with it the floor of the bladder

-creates cystocele - bladder pouch in vagina

Question 6

prostate and seminal vesicles

Answer 6

just posterior to the neck of bladder

-can cause obstruction

Question 7

double ureter

Answer 7

aka bifid

• distinct renal pelvises
• drain to bladder at single ureteral orifice

Question 8

ureteropelvic junction obstruction

Answer 8

UPJ

• most common cause of hydronephrosis in infants and children
• more in males - bilateral
• often with congenital anomalies
• can be agenesis of contralateral kidney
• adults - more common in women - unilateral
• abnormal organization of smooth m. at UPJ leads to excess stroma and collagen between smooth m.

Question 9

diverticula

Answer 9

outpouching of ureter wall

-most asymptomatic - but can recurrent infection

Question 10

ureteritis

Answer 10

not clinically significant

Question 11

ureteritis follicularis

Answer 11

fine granular mucosa surface of uterer

Question 12

ureteritis cystica

Answer 12

mucosa has multiple fine cysts lined with flattened epithelium

Question 13

benign tumors of ureter

Answer 13

typically mesenchyme origin

Question 14

fibro-epithelial polyp

Answer 14

children

• small mass projecting into lumen
• loose vascularized CT overlaid with urothelium

Question 15

urothelial carcinomas

Answer 15

malignant tumors of ureter, renal pelvis, calyces, blader

• 60-70yo
• sometimes multifocal

Question 16

unilateral ureter obstruction

Answer 16

proximal causes

Question 17

bilateral ureter obstruction

Answer 17

distal causes

Question 18

sclerosing retroperitoneal fibrosis

Answer 18

fibrotic proliferative inflammatory process encasing retroperitoneal structures

• causes hydronephrosis
• middle to late aged - more in men
• IgG4-related
• can involve other exocrine organs - pancreas / salivary
• associated with drugs, inflammatory conditions, malignancies
• microscopic - fibrous tissue - lymphocyte infiltreate - IgG4 positive - eosinophilia
• treatment - corticosteroids - stents - surgery (ureterolysis)

Question 19

cystitis

Answer 19

common in young women

Question 20

VUR

Answer 20

most common and serious congenital anomaly

Question 21

congenital vesicouterine fistula

Answer 21

abnormal connections between bladder and vagina, rectum, or uterus

Question 22

acquired diverticula of bladder

Answer 22

often with prostatit enlargement

Question 23

exstrophy of the bladder

Answer 23

developmental failure - anterior abdomen and bladder
-open sac or open to abdominal wall

• exposed mucosa - colonic glandular metaplasia
• subject to infection
• increased risk of adenocarcinoma
• Tx - surgery

Question 24

urachal anomalies

Answer 24

urachus - bladder to allantois

• normally obliterated
• sometimes remains patent
• total - fistulous urinary tract
• partial - urachal cysts

carcinomas may arise from cysts

Question 25

common agents for cystitis

Answer 25

E. coli
proteus
klebsiella
enterobacter

Question 26

cystitis

Answer 26

women more likely - shorter urethra

Question 27

tuberculous cystitis

Answer 27

common with TB

Question 28

irradiation to bladder

Answer 28

radiation cysts

Question 29

cyclophosphamide

Answer 29

antitumor drug - cytotoxic
-may cause hemorrhagic cystitis

also - adenovirus infection causes hemorrhagic cystitis

Question 30

follicular cystitis

Answer 30

presence of lymphoid follicles in bladder mucosa

Question 31

eosinophilic cystitis

Answer 31

submucosal eosinophils

-may indicated systemic allergic disorder

Question 32

triad for cystitis

Answer 32

frequency
lower abdomen pain - suprapubic
dysuria

Question 33

interstitial cystitis

Answer 33

chronic pelvic pain syndrome

• chronic
• more in women
• intermittent suprapubic pain
• frequency, urgency, dysuria, hematuria
• hemorrhages in bladder mucosa

some with hunner ulcers - late (classic,ulcerative) phase

increased mucosal mast cells**

Question 34

increased mucosal mast cells

Answer 34

interstitial cystitis - chronic pelvic pain syndrome

Question 35

malakoplakia

Answer 35

chronic inflammatory reaction

• defects in phagocyte function
• chronic bacterial infection - E. coli, proteus

Question 36

morph of malakoplakia

Answer 36

soft, yellow, raised plaques, 3-4cm, filled with large foamy macrophages
-mixed with multinucleate giant cells and lymphocytes

macrophages - granular cytoplasm
michaelis-gutmann bodies - Ca deposition in macrophages

also in colon, lung, bone, kidney, prostate, epididymis

Question 37

polyploid cystitis

Answer 37

irritation of bladder mucosa

• indwelling catheters or injury
• urothelium is broad bulbous polypoid projections

Question 38

brunn nests

Answer 38

urothelium that grows down into the lamina propria of bladder

Question 39

cystitis glandularis

Answer 39

brunn nests metaplasia to cuboidal or columnar cells

Question 40

cystitis cystica

Answer 40

brunn nests metaplasia to cystic spaces lined by flattened urothelium

Question 41

cystitis cystica et glandularis

Answer 41

combination of cystitis glandularis and cystitis cystica

metaplasia of bladder

Question 42

squamous metaplasia of bladder

Answer 42

response to injury

Question 43

nephrogenic adenoma of bladder

Answer 43

implantation of shed renal tubular cells at site of injured urothelium
-may be replaced by cuboidal - assume papillary growth pattern
typically small lesions - <1cm