Urological Pathology Flashcards
Describe cystitis, its causes, its risk factors, its complications and its treatment
It is infection of the balder and lower urinary tract. It is usually caused by e. coli, but can also be caused by proteus, Klebsiella, Enterobacter and strep faecalis. Predisposing factors include being female, having calculi, have any obstructions, diabetes and being sexually active. Complications are an ascending infection, becoming pyelonephritis and it is treated with a course of trimethoprim/nitrofurantoin for 7-10 days (in men).
Describe urinary calculi and the types
Lifetime risk of 1 with men being 3 times more at risk
Calcium oxalate:
- 75 percent of all stones
- Associated with high calcium (low reabsorption from urine)
Magnesium ammonium phosphate (triple stones)
- 15 percent
- Associated with infection
- Large, staghorn calculi
Uric acid
- 5 percent
- Gout and high cell turnover
- Most are not hyperuraemic
Describe bladder tumours, the risk factors, how they present and how they are diagnosed. Briefly describe the different types
90 per cent of all bladder tumours are transitional cell tumours, with men 3 times more at risk and with 80 per cent of cases appearing in the years 50-80 of life. Risk factors include smoking and exposure to aromatic amines. Clinical features are painless haematuria, frequency, urgency. Diagnosis is with cystoscopy and biopsy.
The main types of TCC are:
Non-invasive papillary
- Frond-like growths
- Can be low or high grade
Infiltrating
- Invasive with different subtypes
- Treatment proportionate to invasion
Flat in-situ
- High grade and invasive
- Increased risk of progression
There are also SCC and adenocarcinomas of the bladder, which are rarer
Describe benign prostatic hyperplasia
BPH is a proliferation of the stromal and epithelial cells of the prostate. It presents with lower urinary tract symptoms and is treated with TURP or alpha reductase inhibitors such as finasteride.
Describe prostatic cancer
This accounts for 25 percent of all male cancers and the most common type is an adenocarcinoma. Risk factors include age, family history and hormonal influences (high oestrogen). They classically arise in the peripheral areas of the prostate and then more centrally, and arise from prostatic intraepithelial neoplasia.
They are graded using the Gleason system (looking at patterns of differentiation and scoring them) and the diagnosis is made with a history, examination and PSA.
Describe prostatitis
Can be acute (with e. coli) or chronic (with or without a history of recurrent UTIs)
Describe testicular tumours
These can be germ cell (95 percent) or sec cord (5 percent)
Germ Cell
- 5 histological subtypes (seminoma, embryonal carcinoma, yolk-sac, choriocarcinoma, post-pubertal teratoma)
- The most common is a seminoma (radiosensitive)
- Teratoma (AFP, HCG and LDH are markers)
- Predisposing factors include cryptorchidism, testicular dysgenesis, IUGR, Kleinfelter’s
Sex chord tumours
- Much more aggressive
- Leydig cell tumours (benign, cause of precocious puberty)
- Sertoli cell tumour (90 percent are benign)
- Lymphoma
Maldescent of the testis occurs in 1 percent of males, and increases a risk of testicular cancer by 3-5 times.
Name some pathologies of the paratesticular region
- Epidydimal cyst
- Epididymitis
- Varicocele
- Hydrocele
- Adenomatoid tumour
Name some pathologies of the penis
- Lichen sclerosis
- Zoon’s balanaitis
- Condylomes
- Peyrone’s disease
- Penile carcinoma
Name some pathologies of the urethra
- Urethritis
- Polyp
- Caruncle
- Carcinoma
- Melanoma
Name some pathologies of the scrotum
- Cyst
- Calcinosis
- Angiokeratomas
- Fournier’s gangrene
- Scrotal SCC
