Urinary tract disorders I Flashcards
Bladder
− Stores the urine
− Void intermittently under voluntary control
The most common diseases of the urinary tract:
− Benign prostatic hyperplasia (BPH) in men
− Urinary tract infection (UTI) in women
− Urinary incontinence
The symptoms that suggest urinary tract diseases:
- frequency of micturition
- dysuria
- haematuria
- urinary retention
What gender is UTI more common in?
women
What is the major form or UTI?
cystitis
What is cystitis?
inflammation of the bladder
common in UTI
What gender is cystitis more common in?
women
Is cystitis acute or chronic?
both
What is cystitis caused by?
E.coli or Proteus
Sterile Cystitis
radiation
drugs
Cystitis Presentation
- urgency
- frequency
- dysuiria
- lower abdominal pain or tenderness
Cystitis Complication
pyelonephritis
Cystitis Pathology
non-specific acute or chronic inflammation
Cystitis Pathology - Acute Cystitis
mucosa becomes hyperaemic
often producing exudate
Cystitis Pathology - Chronic Cystitis
– results from recurrent or persistent infection of the bladder
What does chronic infection of cystitis do?
-> fibrous thickening & scarring; bladder wall less distensible
Cystitis Diagnosis
urine bacteria count
microscopy
WBCs
Cystitis Treatment
- 3-5 days course of antibotics
- high fluid intake - cranberry juice
What should you do if you have recurrent cystitis infection?
investigation
What does metaplasia in the bladder lead to?
the formation of bladder tumours
Urothelium
transitional cell lining
What can undergo metaplastic changes in the bladder?
urothelium
What are the three metaplasia in bladder?
squamous metaplasia
intestinal or glandular metaplasia
nephrogenic metaplasia
Benign tumours of the bladder
rare
2-3% of epithelial tumours
Transitional cell carcinomas
− common malignant tumours arising from transitional cell epithelium
− account for 90%+ of bladder epithelial cell tumours
Transitional Cell Carcinomas
Uncommon under 50 yrs old; more commonly affect males (4 males: 1 female)
Notoriously silent tumours: 50% incurable at diagnosis
Transitional Cell Carcinomas Presentation
painless haematuria
Transitional Cell Carcinomas Symptoms
accompanied by symptoms of UTI
Transitional Cell Carcinomas Symptoms of Local Invasion
ureteric obstruction
Transitional Cell Carcinomas - Risk Factors
smoking
exposure to acrylamide chemical in industry
drugs
- analgesic abuse
- immunosuppressive agents
radiation
Transitional Cell Carcinomas - Pathology
in situ or invasive
graded to I-III according to cytological atypia
Transitional Cell Carcinomas - What are the two main types of cell tumour?
papillary tumour - 70%
sessile (flat) tumour
Transitional carcinoma - clinical features
- painless haematuria
- symptoms of UTI
- symptoms of local invasion
Transitional carcinoma - diagnosis
urine cytological examination
- malignant cells
cystoscopy for pathology
Transitional carcinoma - treatment
according to the stage and histological grade
- tumour resection using diathermy
- radiotherapy
- cystectomy
Transitional carcinoma - prognosis
5 year survival 80% if bladder wall not involved
5% in local invasion on presentation
Urinary Incontinence
involuntary loss of urine
socially distressing
common in elderly - 25% of women and 15% of men over 65
Types of Urinary Incontinence
urge incontinence
stress incontinence
overflow incontinence
functional incontinence
Urge Incontinence
− Due to detrusor overactivity with leakage of urine
(the bladder is perceived to be full)
− As isolated event
− Secondary to local factors (bladder infection, stones) or central factors (stroke, dementia, Parkinson’s disease)
Stress Incontinence
− Occurs when intra-abdominal pressure is increased (cough, sneeze)
− Weak pelvic floor or urethral sphincter
− Common in women after childbirth
Overflow Incontinence
− Leakage of urine from a full distended bladder
Commonly in men with prostatic obstruction
Following spinal cord injury
In women with cystocoeles or after gynaecological surgery
Functional Incontinence
− Passage of urine owing to inability to get to a toilet because of disability (stroke, trauma, unavailability of toilet facilities or dementia)
Urinary Incontinence - Treatment - Urge Incontinence
bladder training
antimuscarininic
treatment of underlying causes
Urinary Incontinence - Treatment - Stress Incontinence
pelvic floor exercises
Urinary Incontinence - Treatment - Overflow Incontinence
removal of obstruction
Urinary Incontinence - Treatment - Functional Incontinence
improves facilities, regular urinary voiding, absorbent padding
