UTI I and II Flashcards
what are the most common diseases of the urinary tract
1) Benign prostatic hyperplasia (BPH) in men
2) Urinary tract infection (UTI) in women
3) Urinary incontinence
which symptoms suggest urinary tract disease
- Frequency of micturition
- Dysuria (pain on urination)
- Haematuria
- Urinary retention
describe UTI
- common
- Incidence 50,000/million/year
- Accounts for 1-2% patients in primary care
- more common in women
- major form of UTI is CYSTITIS
what is cystitis
- Inflammation of the bladder; common in UTI
- More common in women
- Acute or chronic
- Mainly caused by infection; pathogens:
- Most common: E. Coli and Proteus
- Others (Candida albicans, Cryptococcus, Schistosoma, Mycobacterium tuberculosis)
- Sterile cystitis
- Radiation
- Drugs
how does cystitis present
- classic symptoms
1) urgency
2) frequence
3) dysuria
4) lower abdominal pain and tenderness
COMPLICATION: pyelonephritis (inflammation of the kidney)
what is the pathology of cystitis
- Non-specific acute or chronic inflammation
Acute cystitis: mucosa becomes hyperaemic, often producing an exudate
Chronic cystitis: –results from recurrent or persistent infection of the bladder. –Chronic infection leads to fibrous thickening & scarring; bladder wall less distensible
how is cystitis diagnosed an treated
Diagnosis: Urine bacterial count; microscopy, WBCs, Treatment−3-5 day course of antibiotics
−High fluid intake, (cranberry juice)
Recurrent infection: investigation
describe bladder tumours
Metaplasia: urothelium (transitional cell lining) of the bladder can undergo metaplastic changes
- 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
what are transitional cell carcinomas
- Uncommon under 50 yrs old; more commonly affect males (4 males: 1 female)
- Notoriously silent tumours: 50% incurable at diagnosis
- The most common presentation is painless haematuria
- Often accompanied by symptoms of UTI (dysuria, frequency and urgency)
- Symptoms of local invasion: ureteric obstruction
what are the risk factors for transitional cell carcinoma
- smoking
- Exposure to acrylamine chemicals in industry (naphthylamine, benzidine)
- drugs (analgesic abuse, immunosupressive agent like cyclophosphamide)
- radiation
what is the pathology of transitional cell carcinoma
- Two main types of transitional cell tumour: Papillary tumour (70%) Sessile (flat) tumour
- In situ or invasive
- Graded to I-III according to cytological atypia
what are the 4 patterns of urothelial carcinoma
1) papilloma
2) invasive papilloma carcinoma
3) flat non invasive carcinoma
4) flat invasive carcinoma
what are the clinical features of transitional carcinoma
- painless haematuria
- symptoms of UTI:
- dysuria
- frequency
- urgency
- symptoms of local invasion
how is transitional carcinoma diagnosed and treated
Diagnosis:
Urine cytological examination:- malignant cells
Cystoscopy for pathology
Treatment:According to the stage and histological grade
Tumour resection using diathermy
Radiotherapy
Cystectomy
what is the prognosis for transitional carcinoma
Five year survival 80% if bladder wall not involved
5% if local invasion on presentation
what is incontinence
Defined as involuntary loss of urine
Common in the elderly, 25% of women and 15% of man over 65
Socially distressing
what is 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)
what is stress incontinence
Occurs when intra-abdominal pressure is increased (cough, sneeze)−Weak pelvic floor or urethral sphincter−Common in women after childbirth
what is overflow incontincnce
Leakage of urine from a full distended bladderCommonly in men with prostatic obstruction
Following spinal cord injury
In women with cystocoeles or after gynaecological surgery
what is functional incontinence
assage of urine owing to inability to get to a toilet because of disability (stroke, trauma, unavailability of toilet facilities or dementia)
how is incontinence treated
Urge incontinence
- Bladder training
- Antimuscarinics
- Treatment of underlying causes(UTI, bladder stones, tumours)
Stress incontinence
- pelvic floor exercises
Overflow
- removal of obstruction
Functional incontinence
- Improve facilities, regular urinary voiding, absorbent padding
what is the prostate
what is the structure
- A gland that surrounds the bladder neck and proximal urethra
- slowly grows with age
- diseases are common > age 50
- 4 zones: (central, peripheral, transitional, periurethral)
- common prostate diseases:
- Benign prostatic hyperplasia
- Prostate cancer
- Prostatitis - an infection, usually caused by bacteria
describe benign prostatic hyperplasia (BPH)
- non neoplastic enlargement
- common >60 years
- only 10% are symptomatic
- Prostate enlarged with nodule formation
- Histology:
- Fibromuscular & glandular hyperplasia
what are other clinical features of BPH
- Urinary retention
- Cystitis
- Bladder hypertrophy
- Hydronephrosis, pyelonephritis
what are the symptoms of BPH
- Hesitancy in initiation of micturition
- A poor stream
- Dribbling postmicturition
- Frequency and nocturia
what is the examination for BPH
investigation?
- digital Rectal examination for the enlarged prostate (will feel firm, smooth and rubbery)
- if ENLARGED PALPABLE BLADDER then ABDOMINAL EXAMINATION
what is the pathology of BPH
- Nodular hyperplasia
- fibromuscular( stroma- smooth muscle and fibrous tissue)
- glandular
how is BPH treated
MEDICAL:
- alpha-blockers (relax smooth muscle at the bladder neck)
- antiandrogens (prevent testosterone conversion)
SURGICAL:
- transurethral resection (TURP)
- new treatment - PROSTATE ARTERY EMBOLISATION
what is the pathogenesis of BPH
The cause is unknown, but might be related to levels of male sex hormone (testosterone)
hyperplasia (lateral and median lobes) –> compression of urethra –> bladder outflow obstruction
wha are the clinical features and symptoms of BPH
- Hesitancy in initiation ofmicturition
- A poor stream
- Dribbling postmicturition
- Frequency and nocturia
other clinical fetaures: - Urinary retention
- Cystitis (bladder inflammation)
- Bladder hypertrophy
- Hydronephrosis (kidney swells due to urine failing to properly drain from the kidney to the bladder), pyelonephritis (inflammtion of kidney)
describe the incidence of prostate cancer
who doe sit affect
cause
- Very common, the second most common cancer in men (after lung) accounting for 1/4 of all cancers in men
- A disease of elderly men, occurring in 1 in 10 men >70yrs, rare < 55yrs
- The cause is unknown, but there is a link between androgenic hormones and tumour growth
what is the aetiology of prostate cancer
- unknown, but the hormonal changes that occur with increasing age may be involved
- Age-dependent hormonal changes; androgens & hypersensitivity of androgen receptor
- Family history (there is a strong hereditary component)
- Associated with BPH but no proof of causal releationship
what is the pathology of prostate cancer
- HISTOLOGY:Adenocarcinoma
- Mostly in peripheral zone, classically posterior location - this is palpable on examination
- Grading – Gleason (Grade 1-5 depending on glandular differentiation and architectural patterns) classification
- SPREAD:
- local: bladder floor, pelvis, other adjacent structures
- distant metastases: (bone, esp. spine, pelvis, femur, ribs; liver & lungs)
what are the symptoms/ presentation of prostate cancer
- Symptoms of lower urinary tract obstruction
- Hard craggy prostate on rectal examination
- Metastatic disease in the bone; pain
- Asymptomatic carcinoma, found in autopsies
how is prostate cancer diagnosed
- Transrectal ultrasound: size & staging
- Prostatic biopsy:histological diagnosis & Gleason scoring
- Prostate-specific antigen (PSA) high levels detected via blood test - metastases
- EN2 protein excreted by ONLY CANCER prostate cells is a recent discovery (more specific/sensitive to cancer than PSA)
- further testing: MRI- detailed structure if significant chance of spreading; recent advance: mpMRI (multi parametric MRI) . non invasive
how is prostate cancer treated
- surgery (radical prostatectomy)
- hormone manipulation - LHRH analogues; orchidectomy
- radiotherapy
- prognosis is dependent on stage
what are histological patterns typically seen in Gleason pattern 3
- abundant amphophilic cytoplasm
- enlarged nuclei with prominent nucleoli
