Science Quiz / Lower Urinary Tract

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Can you name the Lower Urinary Tract and Male Pathology

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painless hematuria (80%), male 50-80
Nongonococcal urethritis (e.coli) and gonococcal urethritis (n. gonorrhoeae)
Medullary insterstitial gradient, water permeability by collecting duct (ADH)
Most common mesenchymal tumor of bladder in adults
diverticuli, exstrophy, vesicoureteral reflux
dysplasia, genetically instable, p53, chrom 9p, 9q, p16, Rb, carcinoma in situ, high grade20%- high invasion risk
Obstruction- pain in inguinal area, testes, vaginaMost narrow therefore MOST COMMON SITE OF OBSTRUCTION
non-bacterial cystitis associated with allergies, autoimmune, chronic mucosal ulcers and mast cellsinflammation causes dysuria, chronic pain (>6 mo), cystoscopic findings of fissures and punctuate hemorrhages
dilation of collecting system of kidneys (pelvis and calyces)
Obstruction- pain presents in lower quadrants(middle of ureter)
most common site for urothelial carcinoma
Obstruction effect on Renal blood flow (phase I, phase II, phase III)the initial increase in renal blood flow is a distinctive phenomenon due to afferent arteriole dilation and tubuloglomerular feedback
structural impendence of flow of urine anywhere along urinary tract
Most common cause of hydronephrosis in children
Treatment of metastasis
Squamous cell carcinoma, adenocarcinoma, small cell carcinomaSCC associated with schistosome eggs
Prognosis of invasive carcinoma once tumor is in lamina propria
hyperplasia, genetically stable, FGFR3, low grade80%- low invasion risk
Treatment of multiple tumors
papillary branching, nuclear enlargement, local recurrence 50-75%, FGFR3, low proliferative rateCD20, CD44, p53 and p63 alterations can be seen
double ureters, bifid pelvis, diverticula, megaureter
Hydronephrosis in fetus seen on pregnant women's ultrasound
Most common mesenchymal tumor of bladder in infancy
increased urothelial thickness, cytology negative, lesion with arranged cells and minimal archetecture abnl, FGFR330% recur, 5% progress, men > women, >65yo
1% papillary urothelial tumors, F>M, cytology negative, fibrovascular stalks, FGFR3 mutationbenign,
mutations in FGFR3 are associated withdiploidy
white plaques in bladder that result from long term irritation or infection (stones, nonfunctioning bladder, schistosomisias), risk factor for SCC development, keratinizing squamousquamous metaplasia, gross: grey-white areas
Obstruction effect on Ureteral pressure (phase I, II, III)Declines to baseline after 24 hours due to the decrease in GFR
mutations in p53 are associated with aneuploidy
main pathology of BPH (bilateral obstruction)once obstruction is relieved, pt is at risk for dehydration due to decreased expression of aquaporin channels (retain Na+, urea, H2O)
cigarette smoking, arylamines, chronic cystitis (schistosomiasis, UTI, catheter, urolithiasis), cyclophosphamide, analgesic use (phenacetin), pelvic irridiationask about occupation- working with dyes
degenerated von Brunn's nests forming cystic cavities, 60% of bladder
caliculi, strictures, tumors, blood clots, neurogenic
damage to renal parenchyma that results from an obstruction of urine flow
Treatment of CIS, papillary high grade, T1BCG is an attenuated strain of mycobacterium TB, intravesical BCG immunotherapy is one of the most widely used approach to manage superficial bladder cancer. It elicits a local cell-mediated immune reaction that destroys tumor cells. Treats disease and prevents recurrence.
pregnancy, inflammation, endometriosis, tumors
Prognosis of high grade papillary carcinoma 10 year survivial
caruncle, Peyronie disease, CarcinomasPeyronie disease- fibrous bands involving corpus cavernosum of the penis- painful erections and UTI's
frequency, pain, dysuria, fever, e.coli, women
Obstruction effect on GFR (phase I, II, III)
Obstruction- pain presents in upper quadrants
Obstruction that is common in males, rare in femalesBPH
papillary fronds with disordered arrangement (fusion) and atypia, cytology positive, local recurrence 36-60%, progression 40-60%, disease mortality 15%, p53mitotic figures and a fibrovascular core
Most common site of stone obstruction in adults
Prognosis of low grade papillary lesions- 10 year survivial
Treatment of small, papillary tumor, low grade

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