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T Year > Urological Pathology > Flashcards

Urological Pathology Flashcards

1
Q

Urinary tract structure

A

Urinary tract is lined by urothelium which rests on a basement membrane.

the urothelium is a specialised epithelium which is several cell layers thick, allowing it to stretch and distend as needed.

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2
Q

What are the layers of the wall of the renal pelvis, ureter, bladder and urethra?

A
  • urothelium/transitional epithelium
  • lamina propria
  • muscularis propria (detrusor muscle in the bladder)
  • adventitia (perivisceral fat in the bladder)
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3
Q

What is the structure of the prostate?

A

slightly larger than a walnut

surrounds the urethra just below the urinary bladder and it is palpable on rectal examination

has three zones: transition, central and peripheral zones

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4
Q

What is the function of the prostate?

A

produces an alkaline secretion which neutralises the acidic environment of the vaginal.

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5
Q

What are common causes of macroscopic/frank haematuria?

A 
kidney cancer (Renal Cell Carcinoma)
stone in kidney or ureter
trauma
bladder cancer
BPH
infection (bacterial cystitis)
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6
Q

Investigations of macroscopic haematuria?

A

MDU for MC+S
urine cytology
flexible cystoscopy ± biopsy

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7
Q

what do LUTS suggest?

A

a problem in the bladder or prostate

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8
Q

What are causes of LUTS?

A 
BMP
UTI
UT stones
bladder cancer
prostate cancer (late feature)
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9
Q

What is the most common malignant tumour of the kidney?

A

RCC

clear cell is the most common type of RCC

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10
Q

What are risk factors for RCC?

A 
male gender (4:1)
increasing age (>50)
smoking
obesity
familial syndromes eg von Hippel Lindau syndrome
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11
Q

What is the grading system for RCC?

A

Fuhrman grading system
assesses how closely the tumour cell nuclei resemble renal tubule cell nuclei

grade 1: closely resemble normal (less aggressive, better prognosis)

grade 4: largerand pleomorphic (more aggressive, worse prognosis)

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12
Q

Staging of RCC

A

TNM

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13
Q

Clinical presentation of RCC

A

Triad: loin pain, loin mass, haematuria

uncommon in clinical practice!

don’t forget B symptoms!

incidental finding on scan for another reason
S+S of metastatic disease
paraneoplastic sindrome

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14
Q

What is the most common type of bladder cancer?

A

transitional cell carcinoma urothelial carcinoma

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15
Q

What are risk factors for bladder cancer?

A

Cigarette smoking the most important risk factor

industrial exposure to certain industrial dyes and solvents (particularly aryl amines)

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16
Q

What sit he grading of bladder cancer?

A

3 tier system - 1, 2, 3

low grade: grade 1 and most of grade 2
high grade: grade 3 and minority of grade 2

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17
Q

Staging of bladder cancer

A

TNM

superficial tumours are Ta or T1
muscle invasive tumours are T2, T3 or T4
CIs is Tis

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18
Q

What are the three main groups of classification bladder cancer?

A

low risk bladder cancer: superficial tumours (Ta or T1) and low grade

high risk bladder cancer: muscle invasive tumours (T2 or worse) and high grade

carcinoma in situ (CIS): pre cancer

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19
Q

Low risk bladder cancers

A

confined to the mucosa or into the lamina propria
they do NOT invade into the muscularis propria
fond like papillary growths

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20
Q

What are possible consequences following removal of a low risk bladder cancer?

A

a high chance of the tumour recurring as another superficial bladder cancer

a low chance that the tumour will transform into a high risk (muscle invasive) tumour

require regular check cystoscopies for this reason

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21
Q

High risk (muscle invasive) bladder cancer

A

invade into the detrusor muscle or beyond
tend to be solid rather than papillary
much worse prognosis than low risk tumours as more likely to spread to regional nodes and metastasise to distant sites
radical treatment required for cure, often cystectomy with or without other organs such as the uterus

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22
Q

urothelial carcinoma in situ (CIS)

A

flat lesion in which the urothelium contains cells that display the nuclear features associated with malignancy But there is no invasion through the basement membrane

about 40% will progress to muscle invasive cancer if let untreated - more ominous diagnosis than superficial carcinoma!

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23
Q

cytological investigations

A

blue light cystoscopy

urine cytology

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24
Q

What mutations are low risk (superficial) bladder cancers associated with?

A

HRAS and FGFR3

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25
Q

What mutations are CIS and high risk (muscle invasive) bladder cancers associated with?

A

TP53 and RB1

26
Q

What is BPH

A

benign prostatic hyperplasia results from the overgrowth o prostatic tissue in the TRANSITION ZONE of the gland

the overgrowth results in the formation of large nodules which form due to hyperplasia of all the cellular elements in the prostate.

27
Q

what are the complications of BPH?

A

gradual compression of the prostatic urethra causing urinary tract obstruction

the detrusor muscle undergoes compensatory hypertrophy to compensate for this but will eventually decompensated and relax, resulting in chronic urinary retention. this can lead to hydrometer and hydronephrosis

28
Q

hydronephrosis

A

water inside th kidney. refers to dissension and dilatation of the renal pelvis and calyces, usually caused by obstruction of the free flow of urine from the kidney.

untreated it leads to progressive atrophy of the renal parenchyma.

as a consequence there is progressive loss of renal function in both kidneys and the development of chronic kidney injury

29
Q

How might BPH present

A

LUTS
acute urinary retention
urinary tract infection
renal dysfunction

30
Q

clinical presentation of prostate cancer

A

latent prostate cancer - no symptoms at diagnosis. may just be a man in his 50-60s asking for a PSA test which comes back positive resulting in biopsy and diagnosis.

symptomatic prostate cancer - may be due to primary tumour effects of those of metastases (e.g. bone - back pain)

31
Q

which cancers commonly metastasise to bone?

A

BLT Plus Ketchup

Breast
Lung Thyroid
Prostate
Kidney

bone metastases are usually OSTEOLYTIC with the exception of those from prostate cancer which are typically SCLEROTIC

32
Q

what is the most common type of prostate cancer?

A

almost all are adenocarcinomas arising from the epithelial cells lining the acini or ducts of the prostate gland

33
Q

wha t is the premalignant prostate condition?

A

prostatic intraepithelial neoplasia (PIN)

34
Q

how is prostate cancer graded?

A

Gleason scoring system

given 2 scores 1-5 and added together gives a score of 2-10
in practice only 3-5 are given

the gleason grade is very important in helping determine the most appropriate treatment and prognosis for prostate cancer patients

35
Q

how is prostate cancer stand?

A

TNM

36
Q

How is prostate cancer managed?

A

staged
MDT meeting

latent: quite often active surveillance as not causing any problems for the patient

radical prostatectomy (SE: urinary incontinence, erectile dysfunction, bladder neck obstruction and death)

radial radiotherapy (external beam radiation or brachytherapy)

active surveillance

37
Q

where do urinary tract stones most commonly arise?

A

renal calyces and pelvis

38
Q

what i the lifetime risk of urinary tract stone formation?

A

up to 10% of the population

39
Q

What are the most common types of renal calculi

A

calcium oxalate or a mixture of calcium oxalate and calcium phosphate

40
Q

what are causes of hypercalciuria?

A

absorptive hypercalciuria - over absorption from the gut

renal hypercalciuria- defect int he renal tubules which impairs tubular absorption of calcium in the proximal tubule

hypercalcaemia - usually due to primary hyperparathyroidism

41
Q

what is the clinical presentation of urinary tract stones?

A

can be silent, especially larger stone sea stag horn calculus which are often found when investigating haematuria or recurrent UTIs

smaller stones can pass into the ureter and cause ureteric colic. if it becomes impact then the pain gets even worse.

can cause obstruction

42
Q

what are the three most common places of urinary tract stone obstruction?

A

VESICOURETERIC JUNCTION (most common)
pelviureteric junction
pelvic brim

43
Q

complications of urinary tract stone impaction

A

IMMEDIATE:
UTI
pyelonephirits
sepsis

MEDIUM AND LONG TERM:
hydrometer and hydronephrosis
loss of function- unilateral obstructive uropathy
hypertension

44
Q

Treatment of urinary tract stone obstruction

A

emergency nephrostomy to bypass the stone

stone may be removed by stereoscopy and/or laser lithotripsy which breaks the stone up into small pieces which can then be removed

45
Q

causes/risk factors for UTI

A

increased bacterial inoculation:sexual activity, incontinence, constipation

increased binding of uropathogenic bacteria: spermicide use, decreased oestrogen, menopause

decreased urine flow: dehydration, obstructed urinary tract

increased bacterial growth: DM, immunosuppression, obstruction, stones, catheter, renal tract malformation, pregnancy

46
Q

UTI treatment in non-pregnancy women

A

3 day course of trimethoprim or nitrofurantoin

upper UTI broad spectrum e.g. co-amoxiclav. consider hospitalisation and avoid nitro

47
Q

UTI treatment in pregnant women

A

1st trimester AVOID ciprofloxacin and trimethoprim

3rd trimester AVOID nitrofurantoin

48
Q

UTI treatment in men

A

7 day course of trimethoprim or nitrofurantoin

if prostatitis consider longer term (4w) with a fluoroquinolone e.g. ciprofloxacin

49
Q

UTI treatment in catheterised patients

A

change long term catheter before starting antibiotics and refer to local guidelines

50
Q

what makes a UTI complicated?

A

structural or functional abnormality of GU tract

51
Q

risk factors for pyelonephritis

A 
previous UTI
stress incontinence
frequent sexual intercourse
DM
foreign body in urinary tract
anatomical/functional abnormality
immunosuppression
pregnancy
52
Q

risk factors for renal stones

A

family or personal history
dehydration
certain diets e.g. high protein, salt and sugar
obesity
digestive diseases and surgery
other medical conditions e.g. renal tubular acidosis

53
Q

prevention of renal stones

A 
drink plenty, normal calcium intake
thiazide diuretics
oxalate decreased intake (pyridoxine)
struvite - treat infection
urate - allopurinol, urine alkalisation
cysteine - vigorous hydration
54
Q

medical management of BPH

A

alpha blockers: tamsulosin, alfuzosin, doxazosin, terazosin

5alpha-reductase inhibitors: finasteride

55
Q

surgical management of BPH

A

TURP
TUIP
prostatectomy
TULIP

56
Q

what is urge incontinence?

A

leakage and urgency

RFs:
cystitis
bladder stone
bladder obstruction
idiopathic detrusor overactivity
neuropathic detrusor overactivity
57
Q

what is stress incontinence

A

leakage on effort or exertion

RFs:
age, repvious childbirth, hysterectomy, obesity, trauma, previous prostate surgery

58
Q

causes of bladder obstruction

A 
enlarged prostate
previous surgery
bladder stones
urethral stricture
constipation
59
Q

treatment of urge incontinence

A 
resolve underlying pathology
lifestyle changes
anticholinergics
BOTOX
sacral nerve stimulation
surgery (clam cystoscopy)
60
Q

treatment of stress incontinence

A 
pelvic floor exercises
weight loss
stop smoking
avoid constipation
surgery
61
Q

CKD signs and symptoms

A 
oedema
pruritus
arthralgia
enlarged prostate gland
retinopathy
fatigue
nausea and vomiting
anorexia
foamy urine
coca-cola coloured urine
rashes
dyspnoea
orthopnoea
seizures

T Year (18 decks)

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