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Lower Urinary Tract

The Lower Urinary Tract

Epithelium of the UG tract ? * transitional epi. ---> from renal pelvis t some of the urethra
Cells we see in the transitional epi ? * Umbrella cells, under it is the lamina propria which is smooth muscle, and deeper to that is the detrusor muscle
Ureters Overview ? * retroperitoneal and prone to injury and operation mistakes.... * 3 places stones can get stuck: crossing pelvis brim, crossing Iliac As, and entrance to the bladder
Congenital Anomalies of the Ureters ? * Bifid Ureter (usu asympatomatic), Obstructions, and Hydronephrosis
Ureter Inflammation ? * ureteritis follicularis = Lymphoid germinal centers in subepithelial region --> slight elevations of the mucosa with fine granular surface ..... * Or see them lined with little small cysts = Ureteritis cystica
Ureters – Tumors & Tumor-Like Lesions ? BENIGN * Fibroepithelial Polyp (often in kids), loose CT under mucosal tissue..... * Leiomyoma (made of smooth muscle)
Ureters – Tumors & Tumor-Like Lesions ? MALIGNANT * Transitional Cell Carcinoma = usu seen in 6 -7 decades ..... * get obstruction of the lumen (loks likes stuff growing all over the ureter)
Ureters – Obstructive Lesions ? * Hydroureter, Hydronephrosis & Pyelonephritis due to an obstruction and can get infections due to urine stagnation..... * Sclerosing Retroperitoneal Fibrosis = remove it, and it just keeps coming back....* Pregnancy also obstructs it
Urinary Bladder – Congenital Anomalies ? * Diverticuli – pouchlike evaginations of the bladder wall --> urinary stasis and develop stones and infections ..... * Exstrophy = developmental failure in anterior wall of the abdomen & the bladder (Complications = Adenocarcinoma) ......
continued... * Fistulas = wastes coming out of the wrong orifice .... * Urachus = urine out of the belly button
Urinary Bladder - Inflammation ? * Get Acute and Chronis --> biggest issue is pylonephritis, usu from E.Coli, Proteus, Kleb..... *
Common in Egypt & Sudan – predisposes to SCCA of bladder ? (squamous Cell) * Schistosoma haematobium (see a black mass in the middle of the bladder)
Can cause hemorrhagic cystitis ? * cyclophosphamide and adenovirus
Lymphoid follicles within the bladder mucosa & underlying wall; not necessarily associated with infection ? * Follicular cystitis
Submucosal eosinophils; may be subacute inflammation or allergic ? * Eosinophilic cystitis ..... * We See: A triad of frequency (every min), dysuria (hurt to pee) and lower abdominal pain
Urinary Bladder - Cystitis --> Interstitial Cystitis (Chronic Pelvic Pain Syndrome) basics ? * seen in women, biopsy to rule out cancers.... * no infections or fissures at all .... * Associate with Hunners Ulcers (looks like a big white ulcer in the bladder wall) lead to a contracted bladder.....* See suprapubic pain, dysuria, hemauria, & freq.
Urinary Bladder - Cystitis --> Malacoplakia basics ? * from E.Coli and Proteus ..... * Defect in Phagocytic cells .... * See Michaelis-Gutmann bodies (KNOW) .... * Looks like open bladder with white plaques on it
Urinary Bladder – Metaplastic Lesions * Nests of urothelium grow down into lamina propria -> transform into cuboidal or columnar epithelium (cystitis glandularis) or cystic spaces filled with clear fluid lined by flattened urothelium (cystitis cystica) ...* Squamous Met = from injury
Shed renal tubular cells that implant in sites of injured urothelium ? * Nephrogenic Adenoma
Urinary Bladder Neoplasms ? * Urothelial tumors (transitional cell carcinomas) .... * high incidence in smoking and analgesic use ...* the deeper it goes, the worse prognosis.... * From deletions in 9 or 17, which inhibits p53
Types of urinary Neoplasms ? * 4 Types = Papilloma, Invasive, Flat Non-Invasive, and Flat Invasive.... * Can be multifocal = being a mix of different types
Squamous Cell Carcinoma ? * frequent in Sudan and Egypt due to invasion of bladder by Schistsoma haematobium.... * so look for a travel history
Urinary Bladder – Other Tumors ? * Adenocarcinoma from urachus .... * Small Cell Carc. ..... * Children – embryonal rhabdomyosarcoma – polypoid grape-like = sarcoma botryoides ( looks like a red/grape mass)
Urinary Bladder - Obstruction ? * Males = BPH and Females = Cystocele (prolapsed bladder) ..... * see bladder trabeculations .... * due to muscle thinning and we see get urine backing up.... * Can also see in foreign body blocking thing and from Neurogenic Bladder (in quadriplegics)
Urethra - Inflammation ? * see local pain, itching, dysuria, and discharge.... * assume G - diplococci (Gono.) until proven otherwise..... * Also Can cause it --> Reiter’s Syndrome = urethritis, conjunctivitis & arthritis (Can't Pee, See, Climb a Tree)
Urethra – Tumor-Like Lesions ? * Urethral Caruncle = on female external meatus, looks like a red cherry.... * just granulation tumor, and is super painful, excised = cured..can bleed when pt urinated
Can cause Penile curvature & painful coitus ? * Peyronie disease
Urethra – Primary Carcinoma ? * very uncommon, and if seen at the Distal urethra meatus = Squamous Cell Carcinoma (not assoc. w/ Shisto.)
Created by: thamrick800