Urinary Bladder (Twomey) - W4

Question 1

What are some urinary bladder anomalies?

Answer 1

• Diverticula - most acquired due to bladder outlet obstruction (stasis, infection, calculi)
• Patent urachus/urachal cyst - persistent allantoic duct
• Vesicoureteral reflux - pyelonephritis
• Exstrophy - failure of development of anterior abdominal wall (chronic infections, adenocarcinoma)

Question 2

cystitis Symptoms

Answer 2

• Triad
  
  • frequency
  • pain
  • dysuria
• systemically
  
  • fever
  • chills
  • maliaise
  • mental changes

Question 3

What could cause non-infectious cystitis?

Answer 3

• Radiation
• chemoterhapy agents - cyclophosphamide
• interstiital cystitis (hunner ulcer)

Question 4

What are the histologic types of cystitis?

Answer 4

• Acute - PMN’s hypereima, suppurative exudate
• Chronic - lymphocytes hyperemia, hyperplasia, fibrosis
• Hemorrhage - radiation/chemo, adenovirus
• Interstitial
  
  • females, persistant + painful, full thickness inflammation
  • autoimmune?
• Cystitis grandularis - metaplasia or infection
• Malacoplakia - soft yellow raised plaques, lymphocytes, E. coli or proteus

Question 5

Who is transititional cell carcincoma of the urothelial common in?

Answer 5

• 90% of all neoplasms of bladder
• age 50-80
• M:F = MALES MORE
• urban > rural

lung cancer has similar demographics

Question 6

What are the CAUSES of bladder neoplasms?

Answer 6

• tobacco
• Aromatic amines/azo dyes
  
  • ​2-napthylamine
  • aniline dye + rubber industry
• Chronic schistosomiasis - S. haematobium
• Long term analgesics - phenacetin
• long term cyclophosphamide
• Saccharin - artificial sweetener

Question 7

Why are aromatic amines and azo dyes common causes of bladder neoplasms?

Answer 7

• conjugated in vivo w/glucuronic acid which makes them non-toxic.
• Human urine glucuronidase splits the bond exposing the urothelium to carcinogen 15-40 yr latency

Question 8

What are symptoms of bladder neoplasms?

Answer 8

• gross hematuria
  
  • lots of blood + over 50 -> think bladder cancer
• frequency + dysuria
• high risk group

Question 9

How should you evaluate hematuria?

Answer 9

• Urinanalysis
  
  • dipstick - blood
  • micro - casts, RBCs, nothing
• cytourethroscope
• urinary cytology - sensitive 90%
• evaluation of upper tracts

Question 10

What is the number one predictor of prognosis for bladder cancer?

Answer 10

STAGE

• Stage Ta = 90% 5 year surivival
• T2 = up to 80% 5 yr.
• T3 = less than 5 yr. 50-60%
• M1 = less than 10% 5 year survival

Question 11

How do we treat urothelial (TCC) cancer

Answer 11

• low stage
  
  • ​transurethral resection
• High stage (T2/T3)
  
  • cystectomy w/node dissection - morbid, won’t pee normally
  • chemo = no help
• T2, T3 or metastatic
  
  • chemo therapy (gemcitabine, cisplatin) MVAC
  • not much radiation

Question 12

Squamous cell carcinoma

Common

Cause

Prognosis

Answer 12

• 3-7% of epithelial cancers - uncommon in US
• S hematobium (endemic areas) and chronic irriation/inflammation (catheters)
• 70% 1 year mortality

Question 13

2 Non-epithelail tumors (bladder cancer)

Answer 13

• Rhabdomyosarcoma -adult and chlidhood
  
  • males more in childhood
  • good prognosis w/aggressive therapy
• Leiomyosarcoma - adults
  
  • median age = 40 to 60
  • m:f = 3:3
  • bulky invasive tumors w/poor prognosis

Question 14

What are common causes of bladder incontience when sneezing, lifting, valsalva?

Answer 14

• prostate
• hypertrophy/surgery
• muliparity
• obesity