Urinary tract pathology Flashcards
What is the upper urinary tract?
Kidney andUreter
What is the lower urinary tract?
Bladder and urethra
What is sclerosis?
Abnormal hardening of tissue due to overgrowth of fibrous tissue or increase in interstitial tissues
What is urethritis?
Lower urinary tract infection where urethra is inflamed. It is divided into gonococcal and non-gonococcal.
What is gonococcal urethritis?
Urethritis caused by the STI gonorrhoea. Non-gonococcal urethritis is more common.
What is a urethral stricture?
Narrowing of urethra which prevents outflow of urine
What are the causes of urethral strictures?
Trauma due to injury
Inflammation/infection
Iatrogenic
What is the composition of the prostate?
Smooth muscle with A1 adrenergic receptors
What is the histology of the prostate?
Luminal layer of columnar epithelia and basal layer of cuboidal epithelia. These make up majority of prostate cells with remaining cells being stromal cells.
Function of stromal cells of prostate?
Epithelial, fibroblast and smooth muscle cell growth and differentiation
What is the anterior surface of prostate?
Fibromuscular stroma, formed of smooth muscles mixed with fibroblasts
What is the prostate central zone?
Surrounds the ejaculatory duct
Where do prostate carcinomas occur?
Peripheral zone
Which part of the prostate surrounds the urethra?
Transitional zone
What are the risk factors for benign prostactic hyperplasia?
Increasing age, obesity, family history and inactivity
What is the mechanism of benign prostatic hyperplasia?
Increased cellular proliferation of prostate cells such as epithelia/stromal or reduced cell death in the transitional zone. This leads to the formation of a prostatic nodule that compresses the urethra and leads to BOO.
Which hormones are involved in BPH?
Increased levels of Testosterone, Dihydrotestosterone, progesterone and oestrogen.
How is dihydrotestosterone formed?
Testosterone -> dihydrotestosterone by 5-alpha reductase
What are the complications of BPH?
Urination issues with voiding and storage
Urinary retention
Bladder stones and bladder failure
What are the voiding issues in BPH?
Urgency to urinate, nocturia, feeling of incomplete emptying and decreased urine flow
What is a bladder stone?
Urine in the bladder is concentrated and becomes solidified
What is the most common cancer in men in the UK?
Prostate cancer- risk is higher in older men, Afro-Carribean, Obesity and family history
How does prostate cancer occur?
Malignancy with glandular origin so adenocarcinoma formation in the acinar or ductal epithelia which commonly originates in the peripheral zone. It is the most common cancer in men in the UK.
What is a critical stage of prostate cancer?
Absence of basal cell layers so basement membrane can easily be breached by malignant cells.
How does local spread occur in prostate cancer?
Infiltrates past the prostatic capsule
-> Venous flow with common metastasis in the bone
-> Travels along the autonomic nerves.
-> Lymphatic spread
What is lymphatic spread in prostatic cancer?
Via the obturator, iliac and paraortic lymph nodes.
How is prostactic cancer graded?
Gleason grading from 1-5 of the most dominant cell types, with a higher score meaning worse differentiation
Gleason grade 1
Small, uniform glands
Gleason grade 2
More stroma between glands
Gleason grade 3
Distinct margins between glands- moderately differentiated
Gleason grade 4
Irregular masses of neoplastic glands
Gleason grade 5
Occasional gland formaiton -poorly differentiated
What is PSA?
Prostate specific antigen- protease produced by normal and malignant prostatic epithelial cells
What causes false positives in prostate specific antigen test?
BPH
UTI causing prostatitis
Recent ureter catheterisation.
How is prostate cancer categorised?
T in TNM
PSA level
Gleason Grading
What are the risk factors for bladder cancer?
Smoking
Age- elderly
Inflammation
Occupation
What cells are most commonly affected in bladder cancer?
Occurs most commonly in the
1)transitional carcinoma
2) squamous cell carcinoma
3) small
What are the layers of the bladder?
Transitional epithelia
Basement membrane
Lamina propria
Muscularis propria containing detrusor muscle
Adventitia
What is the cause of squamous cell carcinoma?
Metaplasia of the transitional epithelia to squamous cells caused by chronic inflammation from:
Recurrent UTIs
Kidney stones
The fluke/cestode Schistosomiasis hematobomium
What is small cell carcinoma?
Neuroendocrine tumour of sarcomatoid tumour (mix of carcinoma and sarcoma)
Which occupation increases risk of bladder cancer?
Exposure to aromatic amines such as dyes
What are the types of bladder cancer?
Non-muscle invasive and muscle invasive
What is the most common bladder cancer type?
Non muscle invasive bladder cancer
What is non-muscle invasive bladder cancer?
Malignancy of the cells of the inner lining of the bladder which does not invade beyond the muscularis propia. It has a high survival rate of above 80% but has a high risk of recurrence.
How is non-muscle invasive bladder cancer subcategorised?
Low risk: small low grade tumour with no carcinoma in situ
Intermediate risk: large low grade tumours or small high grade tumour
High risk:High grade tumour
25% of non-muscle invasive bladder cancer can progress to muscle invasive bladder cancer
How is non-muscle invasive bladder cancer treated?
Resection of tumour section
Local injection of chemotherapy into the bladder
Cystectomy (removal of the bladder)
What is muscle invasive bladder cancer?
Malignancy which invades beyond the muscularis propia to the detrusor muscle. It has a lower survival rate and has a higher rate of metastasis.
How is muscle invasive bladder cancer treated?
Radical(curative) cystectomy (removal of bladder) Neoadjuvantsurgery/chemotherapy
What is the most common bacterial infection?
UTI- risk increases with age and occurs due to microbial virulence.
What are the causes of UTI?
Cystitis
Prostatitis
Orchitis
Pyelonephritis
What is cystitis?
Cystitis is inflammation of the bladder due to infection with E.Coli.
What is orchitis?
Inflammation of the testicles due to bacterial infection or mumps virus
What is pyelonephritis?
Infection of the kidney/s with dysuria and flank pain,
How does bladder cancer present?
Painless haematuria
Dysuria
Frequency, urgency and urinary retention
Renal colic: pain caused by kidney stone obstruction
What are the virulence factors for UTI?
Adherence via fimbraie
Polysaccharides
Flagella
Toxins
What are the host defences for UTI?
-> Prevention of adherence to UTI via antegrade urinary flow and the presence of Tamm-Hormsfall protein and glucosamines in urine
-> Epithelial exfolation
Pelvic-ureteric junction obstruction
Congenital condition where kidney is blocked at the renal pelvic, detected in antenatal screening
Pelvic-ureteric junction obstruction: extrinsic
Compression due to crossing of vessels
Pelvic-ureteric junction obstruction: intrinsic
What is Deitl’s crisis?
Intermittent pain in the uteropelvic junction with nausea and vomiting due to obstruction
How is pelvic utero-junction obstruction treated?
Pyeloplasty which involves reconstruction of parts of the kidney.
What controls the flow of urine between the ureter and bladder?
Entry of ureter of sufficient length in the vesicoureteric junction which acts as a junction for the passage of urine through a muscular opening in the detrusor muscle and submucosal tunnel.
Vesico-ureteric reflux
Retrograde urinary flow which occurs commonly in female children
What is primary uterovesicoreflux?
Congenital defect in one or both of the ureter where it is too short that results in retrograde urine flow.
What is secondary vesicoureteric
reflux?
Obstruction of the bladder outlet causing retrograde urine flow, commonly due to UTI
Neuropathology of bladder
What is Paquin’s law?
For uterovesical junctions to prevent reflux, ureter tunnel length to diameter ration must be 5:1.
What are urinary tract stones?
Low liquid in the body and high waste/supersaturated urine. Forms calcium oxolate crystals, and is a disorder of calcium-oxolate metabolism.
What are the intrinisc risk factors for kidney stones?
UTI: affect urine pH
Corticosteroid medication: increases Na+ and H20 retention
Neurological disease with spinal cord injury
Malabsoprtion disease such as Crohn’s, reducing water uptake
What are the extrinisc risk factors for urinary stones?
Hotter months
European people
Diet high in salt and low in water
What is the flow of sperm?
Seminiferous tubules -> epididymis -> vas deferens
What is the risk factors for testicular cancer?
White Caucasian Males
HIV
Family History
What is the pathology of testicular cancer?
It is the most common germ cell tumour. This is divided into seminomatous and non-seminomatous
Lymphoma and secondary metastases
Commonly affects younger men between 15-35 years old.
What is testicular torsion?
Testicles are twisted along an axis which occludes blood supply and becomes ischaemic.
What are the risk factors for testicular cancer?
Undescended testes
Male infertility
Family history
Tall stature
What is the presentation of testicular cancer?
Non-tender mass which is hard,irregular and has no sensation.
What is the second most common location for prostate cancer?
Transitional zone which surrounds the urethra.
Central zone is least common.
What are the natural ureter constrictions?
When ureter leaves the renal pelvic
Pelvic brim where the common iliac crosses over and becomes the external iliac
Ureter entry into bladder
->These are common sites where kidney stones can form.
