Week 9Urogenital pathology and UTI Flashcards
What does the benign prostatic hyperplasia consist of?
Consists of overgrowth of the epithelium and fibromuscular tissue of the transition zone and periurethral area.
What is another name for enlargment of prostate?
Also known as nodular hyperplasia or benign prostatic hyperplasia (BPH
What are symtpoms of benign prostatic hyperplasia?
These symptoms, referred to as lower urinary tract symptoms (LUTS), include urgency, difficulty in starting urination, diminished stream size and force, increased frequency, incomplete bladder emptying, and nocturia.
What is the cause of symptoms in benign prostatic hyperplasia?
Symptoms are caused by interference with muscular sphincteric function and by obstruction of urine flow through the prostatic urethra.
What is the structure of a normal prostate?
The normal prostate contains several distinct regions, including a central zone (CZ), a peripheral zone (PZ), a transitional zone (TZ), and a periurethral zone
What area of the prostate does carcinomas usually arise from?
Most carcinomas arise from the peripheral glands of the organ and may be palpable during digital examination of the rectum.
What area oft he prostate is affected by nodular hyperplasia?
Nodular hyperplasia, in contrast, arises from more centrally situated glands and is more likely to produce urinary obstruction early than is carcinoma.
What is the three patholgic cahnges in the development of nodular hyperplasia?
- Nodule formation
- Diffuse enlargement of the transition zone and periurethral tissue
- Enlargement of nodules
What patholgic changes do you see in nodular hyperplasia in a man younger than 70?
Diffuse enlargement of the transition zone and periurethral tissue
What patholgic changes do you see in nodular hyperplasia in older men?
Nodule formation
Enlargement of nodules
What process is impaired in nodular hyperplasia?
It is believed that the main component of the “hyperplastic” process is impaired cell death. It has been proposed that there is an overall reduction of the rate of cell death, resulting in the accumulation of senescent cells in the prostate.
What is the role of androgens in nodular hyperplasia?
Androgens (mainly DHT) which are required for the development of BPH, can not only increase cellular proliferation, but also inhibit cell death.
Is prostate adenocarcinoma common under 40?
No it is rare but rapidly increase in icidence after 40
Do most people die of prostate cancer?
No most people have prostate cancer when they die but they do not die of it
What is the treatment of cancer of the prostate?
Cancer of the prostate is treated by surgery, radiation therapy, and hormonal manipulations
How long should people expect to live after recieving treatment for prostate cancer?
For about 15 years
What is the common treatment for clinically localized prostate cancer?
Radical prostatectomy
What is the prognosis based on following radical prostatectomy?
Based on the pathologic stage, margin status, and Gleason grade.
What is the alternative treatment for localized prostaet cancer?
External-beam radiation therapy,
Interstitial radiation therapy (brachytherapy).
What is a alternatie use of external beam radiation therapy?
External-beam radiation therapy is also used to treat prostate cancer that is too locally advanced to be cured by surgery
What factores are thought to play a role in prostate carcinoma?
Age, race, family history, hormone levels, and environmental influences (e.g. increased consumption of fats) are suspected to play a role.
What is the role of androgens in prostate cancer?
The importance of androgens in maintaining the growth and survival of prostate cancer cells
What can be done to reduce the role of adrogens in prostate cancer?
Throughof castration or treatment with anti-androgens, which usually induce disease regression.
What part of the urinary tract flis sterile?
upper urinary tract: Kidneys/ureters are sterile and not suppose to see any flora
Is the bladder sterile?
Usually considered to be sterile but this may not be the case1
What type of flora is found in the urethra?
Perineal flora
Skin/lower GI tract flora
What is perineal flora?
Most skin flora
What is skin flora predominantly?
Predominantly coagulase-negative staphylococci
What is the relationship between the bacteria on the skin near a orrifice and bacteria near the orrifice?
Qualitatively, the bacteria on the skin near any body orifice may be similar to those in the orifice”
What is pyelonephritis?
Upper urinary tract infection
Infection of kidney and/or renal pelvis
Does pyelonephritis have symptoms of upper or lower unirary tract infection?
Has lower symptoms of lower uti
What are the different lower GI tract floras?
Anaerobic bacteria
Aerobic bacteria
Enterobacteriaceae (“enteric Gram-negative bacilli”, “coliforms”)
Gram-positive cocci
Enterococcus spp.
What is cystitis?
Lower urinary tract infection
What are the syndrome of cystitis?
Dysuria Urinary frequency Urgency Supra-pubic pain/tenderness Polyuria, nocturia, haematuria
What are the characteristic symptoms of pyelonephritis?
Loin/abdominal pain/tenderness
Fever
What are other evidence of system infection caused by pyelonephritis?
Rigors, nausea, vomiting, diarrhoea
Elavated CRP, WBC
What is urethral syndrome?
abacterial cystitis, frequency-dysuria syndrome
Who does Urehtral syndrome usually affect?
Mostly affects 30-50 yr old women
Is Urethral syndrome caused by infection?
Symptoms of lower UTI without demonstrable infection
What are possible causes of Urehtral syndrome?
inflammation of Skene glands
paraurethral glands (the “female prostate”),
A reaction to certain foods,
Environmental chemicals
Hypersensitivity following urinary tract infection, and traumatic sexual intercourse
What is definition of significant bacteriuria?
105 cfu/mL
What is the limitations of identifying the amount of bactteria?
Bacterial count is on a normal curve (see next slide)
Many symptomatic females have bacterial counts of
What is the rate at which there is probably infection?
104-105 cfu/mL
What is a defintion of asymptomatic bacteriuria?
Significant bacteriuria that involves only a single organism
No symptoms of urinary tract infection
What is sterile pyuria?
Sterile pyuria is the presence of elevated numbers of white cells in urine which appears sterile using standard culture techniques.
What are the predisposing factors of UTI?
Female sex
Instrumentation
Sexual intercourse –>
Associated with recent sexual intercourse and commoner in sexually active women
Urinary stasis
Fistulae
What is the ratio of sex for UTI?
10:1 female:male ratio
Give examples of urinary stasis that predispose someone to UTI?
Pregnancy, prostatic hypertrophy, stones, strictures, neoplasia, residual urine
What fistulae predispose someone to a UTI?
Recto-vesical, vesico-vaginal
What congeintal abronmalitis predispose someone to UTI?
Vesico-ureteric reflux (VUR)
What is Vesicoureteral reflux ?
Vesicoureteral reflux (VUR) is the backward flow of urine from the bladder into the kidneys
What is vesicovaginal fistula?
A hole that develops between the vagina and the bladder, resulting in uncontrollable leaking of urine through the vagina.
What are the sources of infection of UTI?
Perineum
Movement of bacteria along a lumen
Fistulae
Movement of bacteria from genital/GI tract to urinary tract
Haematogenous
Seeding of infection from the blood (rare)
What is the main organism that causes UTI?
E.coli causes 70-80% in GP and 50% in hospitals
Does sterile pyuria relate to UTI?
Sterile pyuria is often found in female patients with symptoms of urinary tract infection (UTI).
What are the causes of sterile pyuria?
Inhibition of bacterial growth
“Fastidious” (hard to grow) organisms
Urinary tract inflammation –> Renal or bladder stones
Other renal disease
What are the Fastidious” (hard to grow) organisms that cause sterile pyuria?
Mycobacterium tuberculosis, Haemophilus spp., Neisseria gonorrhoeae
Anaerobes
What are you testing for when doing dipstick testing of UTI?
Blood
Protein
Nitrite
White blood cells (leucocyte esterase)
When does dipstick testing of UTI have no diagnostic value?
In patients with indwelling urinary catheters unless these have been placed very recently.
How can a catheter cause bacteriuria?
Long-term indwelling catheterization
What is bacteriuria?
Bacteria in the urine
What is bacteraemia?
Bacteria in the blood
When would antibiotic prophlylaxis be used when placing a catheter?
History of symptomatic urinary catheter-associated infection with previous catheter changes
Purulent urethral/suprapubic catheter exit site discharge
Catheter or meatal/suprapubic catheter exit site colonisation with Staphylococcus aureus (including MRSA).
What are the samples to test in micriological investigations?
Urine
Blood –> in suspected pyelonephritis
What test are done in microbiological investigation of UTI?
Microscopy, culture and sensitivity testing
What are the two types of urine test commonly done?
Mid-stream urine testing
Special tests
What is special tests?
Early morning urine (EMU) 3
Whole contents of bladder
Suspected urinary tuberculosis
Why would you do further investigations of a UTI?
If there is Recurrent UTI
Any UTI in male patient
Any UTI in childhood
Pyelonephritis
What are the further investigations done for UTI?
Renal tract ultrasound scan –> look for congenital abnormalities or kidney stones
Specialised tests Isotope scans (DMSA, DTPA, MAG3), micturating cystourethrogram
What are the requirments needed to use antibiotics for UTI?
Present in urine Minimally toxic Effective against likely organisms Easily administered Cheap Usually oral
What is the common antibiotics used to treat UTI’s?
Nitrofurantoin
Pivmecillinam
Trimethoprim
Fosfomycin
What is Cystitis?
Inflammation of the urinary bladder
What is the treatment for a female with cystitis?
Treatment pre-empts microbiology results
Short course of antibiotics
3-days
What is the treatment for males with cystitis or reccurent symptoms?
Longer course of 7 days
What is the empiric therapy of pyelonephritis?
Cefuroxime, ciprofloxacin
Piperacillin-tazobactam (if >65 yrs old)
What is the target therapy of pyelonephritis?
Based on sensitivity results
What is the duration of treatment of pyelonephritis?
7-14 days depending on antibiotic used
What groups of patients do you treat that have asymptomatic bacteriuria?
Pregnant
Association with upper UTI, pre-term delivery, and low birth weight babies
Infant
Prevention of pyelonephritis and renal damage
Prior to urological procedures
Prevention of UTI/bacteraemia
In what group of people is Seminoma testicular tumor common in?
Most commonly in 35-45 years old, uncommon in men over 50 years of age, and rare in children.
What is the clinical presentation of seminoma?
The clinical presentation includes testicular enlargement, with or without pain (>70%) and metastases (10%)
What are the rare syptoms of seminoma?
gynecomastia, exophthalmos, and infertility
Do all patients with Seminoma have syptoms?
No some don’t
What is elevated in the serum in patients with Seminoma?
Elevated serum PLAP and hCG seen in 40% and 10% of patients, respectively; the latter is the cause of gynecomastia.
What is the macro description of a seminoma?
: well-demarcated, cream-colored, homogeneous, and coarsely lobulated.
What is a micro description of seminoma?
Monotonous polygonal cells with mostly clear cytoplasm and central nuclei divided into lobules by thin bands of fibrovascular stroma.
Who is Teratoma common in?
Most common in the first and second decades of life.
What is the presentation of teratoma?
Gradual testicular swelling with or without pain
When it mature teratoma aggressive and malignant?
Although mature teratoma is almost always benign in prepubertal patients, it can pursue an aggressive clinical course after puberty
Does pure teratomatous tissue secrete tumour markers?
Pure teratomatous tissues do not secrete tumour markers.
What is the macro charactersistics of teratoma?
Macro: well-demarcated solid or multicystic.
what is a micro appearance of teratoma?
Micro: an admixture of ectoderm, endoderm, and mesoderm
What is a characteristic of immature teratoma?
Cells that don’t look like they come from anywhere in the body
What is epididymoorchitis?
Can be acute or chronic - inflammation of the epididymis and testis, caused by infection
What is Idiopathic granulomatous orchitis ?
Is Inflammatory condition of the testis with the formation of granulomas with unknown cause
Who does Idiopathic granulomatous orchitis effect and what are the symptoms?
Typically in older adults, often with associated symptoms of UTI, trauma, or flu-like illness.
What is the effect of Idiopathic granulomatous orchitis on the testes?
The testis becomes swollen, painful, and tender initially but later may have a residual mass indistinguishable from a neoplasm, prompting orchiectomy.
When does sarcoidosis commonly affect testes?
Sarcoidosis can affect the testis, and can mimic malignancy, particularly if accompanied by radiologic pulmonary abnormalities..
What is malakoplakia?
Malakoplakia is a rare inflammatory condition which makes its presence known as a papule, plaque or ulceration that usually affects the genitourinary tract
What part of the genitourinary tract is affected by malakoplakia?
Malakoplakia may affect only the testis, or less commonly, both testis and epididymis,
What is the consequence of malakolakia?
Results in formation of soft yellow, tan, or brown nodules that replace normal testicular parenchyma.
What are the histological appearnce of malakolakia?
The tubules and interstitium are extensively infiltrated by large histiocytes that have abundant eosinophilic granular cytoplasm
What is Sperm Granuloma?
An exuberant foreign body giant cell reaction to extravasated sperm
In who does sperm granuloma occurs in?
Occurs in up to 42% of patients after vasectomy and 2.5% of routine autopsies
What are the symptoms of sperm granuloma?
Patients may have no symptoms, but often present with a history of pain and swelling of the upper pole of the epididymis, spermatic cord, and, rarely, the testis
What are the 4 main components of clinical presentation of tuberculosis orchitis?
1) Painless scrotal swelling 2) Unilateral or bilateral mass 3) Infertility 4) Scrotal fistula
Where in the male genital tract is there tuberculous involvement?
The epididymis is a reservoir
What is cryptorchidism?
Is the absence of one or both testes from the scrotum
What percentage of cryptorchidism results in a empty scrotum?
25%
Where is the testes usually found in cryptorchidism?
These testes most frequently are found in the inguinal canal or upper scrotum; arrest within the abdomen is less frequent.
What are the congenital caues of cryptorchidism?
Congenital: caused by anomalies in anatomic development or hormonal mechanisms involved in testicular descent.
What are the acquired causes of cryptorchidism?
Acquired: postoperative or spontaneous ascent due to various mechanisms: inability of the spermatic blood vessels to grow adequately, anomalous insertion of the gubernaculum, failure in reabsorption of the vaginal process and failure in postnatal elongation of the spermatic cord.
What are the complications of cryptorchidism?
Complications: Testicular atrophy, infertility, carcinoma (TGCTs)
What is HYPOGONADISM?
Testicular failure which causes reduction or absence of hormone secretion or other physiological activity of the gonads
What are primary causes of testicular failure?
Primary – undescended testis, Klinefelter syndrome, hemochromatosis, mumps, orchitis, trauma, cystic fibrosis, testicular torsionand varicocele.
What are secondary causes of testicular failure?
Secondary – pituitary failure, drugs (glucocorticoids, ketoconazole, chemotherapy, and opioids), obesity and aging.
What hormone do obese people produce that causes testicualr failure?
Estrogen
Is cryptorchidism more common on the right or the left?
The right
