The Lower Urinary Tract
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| Epithelium of the UG tract ? | * transitional epi. ---> from renal pelvis t some of the urethra
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| 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
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| 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
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| Congenital Anomalies of the Ureters ? | * Bifid Ureter (usu asympatomatic), Obstructions, and Hydronephrosis
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| 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
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| Ureters – Tumors & Tumor-Like Lesions ? BENIGN | * Fibroepithelial Polyp (often in kids), loose CT under mucosal tissue..... * Leiomyoma
(made of smooth muscle)
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| 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)
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| 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
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| 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)
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| continued... | * Fistulas = wastes coming out of the wrong orifice .... * Urachus = urine out of the belly button
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| Urinary Bladder - Inflammation ? | * Get Acute and Chronis --> biggest issue is pylonephritis, usu from E.Coli, Proteus, Kleb..... *
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| Common in Egypt & Sudan – predisposes to SCCA of bladder ? (squamous Cell) | * Schistosoma haematobium (see a black mass in the middle of the bladder)
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| Can cause hemorrhagic cystitis ? | * cyclophosphamide and adenovirus
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| Lymphoid follicles within the bladder mucosa & underlying wall; not necessarily associated with infection ? | * Follicular cystitis
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| 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
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| 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.
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| 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
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| 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
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| Shed renal tubular cells that implant in sites of injured urothelium ? | * Nephrogenic Adenoma
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| 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
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| Types of urinary Neoplasms ? | * 4 Types = Papilloma, Invasive, Flat Non-Invasive, and Flat Invasive.... * Can be multifocal = being a mix of different types
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| Squamous Cell Carcinoma ? | * frequent in Sudan and Egypt due
to invasion of bladder by Schistsoma haematobium.... * so look for a travel history
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| Urinary Bladder – Other Tumors ? | * Adenocarcinoma from urachus .... * Small Cell Carc. ..... * Children – embryonal rhabdomyosarcoma – polypoid grape-like = sarcoma botryoides ( looks like a red/grape mass)
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| 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)
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| 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)
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| 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
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| Can cause Penile curvature & painful coitus ? | * Peyronie disease
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| Urethra – Primary Carcinoma ? | * very uncommon, and if seen at the Distal urethra meatus = Squamous Cell Carcinoma (not assoc. w/ Shisto.)
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