Renal: Lower Urinary Tract Pathology

Front 1

Pathogenesis of this.

Back 1

Bifid ureter
- defective formation of ampullary bud which arise from distal mesonephric dut during 4th week of development

Front 2

What should you do when you see someoen who has this?

Back 2

Vesicoureteral reflux
- should screen all siblings

Front 3

Pathogenesis of vesicoureteral reflux.

Back 3

- deficient submucosa or muscularis propria in distal ureter -> incompetent uretero-vesicle juction -> reflux of urine

Front 4

What is this disease?

- 2 ureters for one kidney
- urethral dribbling, epididymitis, pyelonephritis, vaginal :discharge"
- 2 separate bladder orifice

Back 4

duplex ureters

Front 5

What is the most common ureteral anomaly requiring surgery?

Back 5

vesicoureteral reflux

Front 6

What is the most common congenital cause of ureteral obstruction?

Back 6

ureteropelvic junction obstruction at kidney

Front 7

Pathogenesis of ureteropelvic junction obstruction at kidney?

Back 7

- defective mucularis propria (75%): too thick
- renal nonrotation (25%): renal pelvis becomes anterior, prone to obstruction by renal arteries/veins

Front 8

What is this disease?

Back 8

ureteropelvic obstruction at kidney
- more in boys, adult women

Front 9

What is this disease?

Back 9

ureterocele
- atrophic muscularis propria -> dilation of distal ureter within bladder
- usually combined with bifid or duplex ureters

Front 10

What is this disease?

Back 10

ureteral dysplasia
- inadequate and disorganized smooth muscle -> dilation, convolution, abnormal displacement of ureters

Front 11

What is this process called?

Back 11

urothelial hyperplasia
- inflammation: lymphocytes
- adjacent to neoplasm
- 7-8 cell layers thick (3-5 cell layer is normal)

Front 12

What is the original cell type?

Back 12

squamous metaplasia
- original cell: urothelial cell

Front 13

What is this disease?

Back 13

retroperitoneal fibrosis
- 50% idiopathic
- secondary cause: drugs, surgery, radiation, neoplasms
- cellular fibrosis with no atypia, fibrosis invades skeletal muscle

Front 14

What is the most common form of urothelial metaplasia?

Back 14

squamous

Front 15

Squamous metaplasia is more common in which part of the urinary tract?

Back 15

lower urinary tract

Front 16

Pathogenesis of squamous metaplasia.

Back 16

- chronic inflammation: infections, catheters, recurrent calculi

Front 17

Name some neoplasms of the ureter.

Back 17

- papilloma
- urothelial carcinoma of ureters

Front 18

Name some neoplasms of renal pelvis.

Back 18

- urothelial carcinoma of renal pelvis
- squamous cell carcinima of renal pelvis

Front 19

What is this disease of the ureter?

- hematuria
- lesion as shown

Back 19

inverted papilloma
- non-dysplastic urothelial cells

Front 20

What is this disease of the ureter?

Back 20

typical papilloma
- exophytic growth of non-dysplastic urothelial cells

Front 21

What is this disease?

- hematuria, flanking pain
- lesion as shown

Back 21

urothelial carcinoma of the pelvis
- soft papillary tumor fills renal pelvis
- lumen filled with neoplastic urothelial cells

Front 22

What is this disease? prognosis?

Back 22

squamous cell carcinoma of the pelvis
- high stage at diagnosis, rapid growers

Front 23

What are some risk factors for urothelial cell carcinoma of ureters?

Back 23

- smoking
- industrial chemicals
- phenacetin abuse
- thorium containing radiographic material

Front 24

What are some risk factors for squamous cell carcinoma of the pelvis?

Back 24

- recurrent calculi
- chronic infections

Front 25

What is this disease?

Back 25

urachus
- urachal cysts remnants
- risk for adenocarcinoma

Front 26

What is this disease? What are some causes?

Back 26

Diverticulum
- congenital : localized deficiency in muscularis propria
- acquired: increased pressure in bladder lumen (prostatic hypertrophy, abnormal descent of uterus

Front 27

What is this disease?

Back 27

extrophy
- bladder communicates with surface of body through a large defect or lies externally as an open sac

Front 28

Which is more common?

- congenital bladder diverticulum
- acquired bladder diverticulum

Back 28

acquired
- prostatic hypertrophy in male
- abnormal descent of uterus pressing on urethra in female

Front 29

Clinical impact of bladder diverticulum.

Back 29

urinary stasis -> infection, calculi, carcinoma

Front 30

What is this disease?

- dysuria, frequency, urgency
- suprapubic dyscomfort

Back 30

acute cystitis
- GNB of enteric origin: E. Coli, protus, klebsiella
- picture showed mucosal hyperemia

Front 31

What can cause this in the bladder?

Back 31

hemorrhagic cystitis
- post cyclophosphamide

Front 32

What is this disease?

Back 32

chronic follicular cystitis

Front 33

What type of cystitis is this?

Back 33

interstitial cystitis (Hunner ulcer)
- transmural chronic inflammation with extensive fibrous scarring lamina propria and muscularis propria.

Front 34

What is this disease?

Back 34

malakoplakia
- defective macrophage causing macrophage overload with undigested bacterial products
- picture showed michaelis-gutman bodies

Front 35

What is this?

Back 35

cystitis cystica (epithelial metaplasia within urothelium)

Front 36

What is this?

Back 36

cystitis glandularis (epithelial metaplasia of intestinal type)
- lined by mucin-producing goblet cells
- risk for bladder adenocarcinoma

Front 37

What is this?

Back 37

keratinizing squamous metaplasia

Front 38

What are some etiology of chronic cystiits?

Back 38

- TB, fungi in immunosuppressed
- schistosomiasis in middle east, Egypt
- cyclophosphamide (hemorrhagic)
- radiation: inflammation, vascular damage, fibrosis

Front 39

Sequalae of chronic cystitis.

Back 39

- pyelonephritis: retrograde spread of organism
- sepsis
- epithelial dysplasia

Front 40

What is this disease?

- ulcers in bladder
- transmural inflammation with extensive fibrous scarring

Back 40

Interstitial cystitis (Hunner ulcer)
- unknown etiology, autoimmune related

Front 41

What are some epithelial metaplasia in the bladder?

Back 41

- cystitis cystica: cysts within urothelium
- cystica glandularis: colonic epithelium
- keratinizing squamous metaplasia

Front 42

Name some types of neoplasms in the bladder.

Back 42

- benign urothelial papilloma
- urothelial carcinoma
- squamous carcinoma
- adenocarcinoma

Front 43

Where is this most likely to be found in the bladder?

Back 43

trigone area or at bladder neck

Front 44

What type of urothelial carcinoma is this?

Back 44

papilloma
- exophytic
- low grade
- cured by complete excision

Front 45

What type of urothelial carcinoma is this?

Back 45

invasive papillary carcinoma:
- exophytic
- not cured by excision

Front 46

What type of urothelial carcinoma is this?

Back 46

flat non-invasive carcinoma
- most treat the whole bladder

Front 47

What type of urothelial carcinoma is this?

Back 47

flat invasive carcinoma
- high grade and metastasize early
- radical cystectomy and radiation

Front 48

What disease of bladder is this?

Back 48

squamous carcinoma
- 70% bladder cancer in areas endemic ti schistosomiasis (middle east, Egypt)

Front 49

What is this? what type of bladder cancer is this associated with?

Back 49

squamous carcinoma
- schistosomiasis haematobium (picture)

Front 50

What is this bladder disease?

Back 50

adenocarcinoma
- 1/3 urachal
- 85% carcinoma arising in extrophy

Front 51

What are some congenital lesions in the urethra?

Back 51

- urethral valves
- diverticula: almost always in females
- urethral polyps: exclusively in males

Front 52

What is this congenital anomaly in urethra?

- almost always in female

Back 52

diverticula

Front 53

What is this congenital anomaly in urethra?

- exclusively in males

Back 53

urethral polyps
- arise in prostatic urethra, adjacent to verumontanum
- hematuria, urinary retention, infection

Front 54

What can cause urethral valves in adult men?

Back 54

- bladder neck hypertrophy -> posterior urethral valves

Front 55

What is this disease?\

- local pain, itching
- discharge

Back 55

infectious urethritis
- chlamydia
- gonorrhea
- enteric GNR
- ureaplasma

Front 56

What is this disease?

- urethritis
- arthritis
- mucocutaneous lesion

Back 56

reiter's syndrome
- mostly in males
- immune complex deposition preceded by vernereal or enteric infection

Front 57

What is a cause of benign papilloma in the urethra?

Back 57

HPV (squamous)

Front 58

What is this urethral disease?

Back 58

caruncle
- ulcerated urothelial or squamous epithelial surface with core of exuberant vascularized connective tissue infiltrated by leukocytes
- painful, bleeds easily

Front 59

Who is more likely to have this?

Back 59

urethal squamous carcinoma
- more likely in females
- must differentiate from bladder carcinoma