Chapter 21-flashcards
most common cause of hydronephrosis in infants and children
Uteropelvic junction
Adults UPJ
more common in women and is most often unilateral.
origin of benign tumors
mesenchymal origin
a tumor-like lesion often occurring in children, is composed of loose, vascularized connective tissue overlaid by urothelium
Fibroepithelial polyp
Extrinsic and intrinsic lesion may obstrcut the ureters and may give rise to
hydroureter, hydronephrosis, and pyelonephritis
Unilateral obstruction typically results from
proximal intrinsic or extrinsic causes (e.g., stones, neoplasms etc.)
bilateral obstruction arises from
distal causes, such as nodular hyperplasia of the prostate
characterized by a fibrotic proliferative inflammatory process that encases retroperitoneal structures and causes hydronephrosis.
Sclerosing Retroperitoneal Fibrosis
recently described entity associated with sclerosing retroperitoneal fibrosis
IgG4- related disease
Other etiologies for retroperitoneal fibrosis
- drug exposures (ergot derivatives, β-adrenergic blockers), -inflammatory conditions (vasculitis, diverticulitis, Crohn disease), - malignancies (lymphomas, urinary tract carcinomas) -
predisposes to ascending pyelonephritis and loss of renal function. Abnormal connections between the bladder and the vagina, rectum, or uterus may create congenital vesicouterine fistulae.
Vesicoureteral reflux
pouch-like invaginations of the bladder wall that vary from less than 1 cm to 10 cm in diameter and may be congenital or acquired.
Diverticula
due to a focal failure of development of the normal musculature or to a urinary tract obstruction during fetal development.
Congenital diverticula
are most often associated with prostatic hyperplasia, producing urinary outflow obstruction.
Acquired diverticula
developmental failure in the anterior wall of the abdomen and the bladder.
Exstrophy of the bladder
Exstrophy is associated with an increased risk of
adenocarcinoma
only a central region of patent urachus persists
urachal cyst
frequently preceded by infection of the urinary bladder, with retrograde spread of microorganisms into the kidneys and their collecting systems
Bacterial pyelonephritis
most common etiologic agents of cystitis are the coliforms
Escherichia coli, followed by Proteus, Klebsiella, and Enterobacter
almost always a sequel to renal tuberculosis.
Tuberculous cystitis
cryptococcal agents may cause cystitis, particularly in immunosuppressed patients or those receiving long-term antibiotics
Candida albicans
an important cause of cystitis in certain African and Middle Eastern countries.
Schistosomiasis (Schistosoma haematobium)
may result in hemorrhagic cystitis.
Adenovirus and BK virus
Gas-forming bacteria (such as Clostridium perfringens) results
emphysematous cystitis
Cytotoxic agents, such as cyclophosphamide may cause
hemorrhagic cystitis
may occur following the irradiation of the bladder region.
radiation cystitis
characterized by the presence of lymphoid follicles within the bladder mucosa and underlying wall.
Follicular cystitis
manifested by infiltration of the submucosa by eosinophils, typically is a nonspecific subacute inflammation but may also be a manifestation of a systemic allergic disorder.
Eosinophilic cystitis,
All forms of cystitis are characterized by a triad of symptoms:
(1) frequency, which in acute cases may necessitate urination every 15 to 20 minutes; (2) lower abdominal pain localized over the bladder region or in the suprapubic region; and (3) dysuria (pain or burning on urination).
- an unpleasant sensation (pain, pressure, discomfort) perceived to be related to the urinary bladder, associated with urinary tract symptoms of more than six weeks duration, in the absence of infection or other identifiable causes.” - characterized by intermittent, often severe, suprapubic pain; urinary frequency; urgency; hematuria; and dysuria.
Interstitial Cystitis (Chronic Pelvic Pain Syndrome).
findings include mucosal fissures and punctate hemorrhages (glomerulations).
Interstitial Cystitis (Chronic Pelvic Pain Syndrome).
special form of transitional
epithelium
urothelium.
the most common cause of hydronephrosis in infants and children.
Ureteropelvic junction (UPJ) obstruction
Benign tumors are generally of
mesenchymal origin.
a tumor-like lesion often occurring in children, is composed of loose, vascularized connective tissue overlaid by urothelium
Fibroepithelial polyp
Major intrinsic cause of ureteral obstruction
Calculi
Strictures
Tumors
Blood Clots
Neurogenic
Major EXTRINSIC cause of ureteral obstruction
Pregnancy
Periureteral inflammation
Endometriosis
Tumors
Most common MALIGNANT TUMOR of urinary
Urothelial Carcinoma
the most common and serious
congenital anomaly of urinary bladder
Vesicoureteral reflux
IgG4-related or idiopathic (Ormond disease)
Sclerosing retroperitoneal fibrosis:
most
often associated with prostatic hyperplasia, producing
urinary outflow obstruction.
Acquired diverticula
Exstrophy of the bladder may cause...
glandular metaplasia and can cause chronic infection to the upper urinary tract
What neoplasm is mostly seen with congenital bladder disorders
Adenocarcinoma
most common etiologic agents of cystitis
E. Coli, Proteus, Klebsiella, eneterobacter
cryptococcal agents may cause cystitis, particularly patients who are
immunosuppressed patients or those
receiving long-term antibiotic
parasitic cause of cystitis in certain African and Middle Eastern Countries
Schistosoma Haematobium
Viral causes for cytitis
adenovirus
frequency, which in acute cases may necessitate urination
every 15 to 20 minutes lower abdominal pain localized
over the bladder region or in the suprapubic region and dysuria
Cystisis
This syndome is unknown etiology mostly in women, with associated pain and unpleasant sensation
Interstitial Cystitis
type of cytitis who have chronic pelvic pain, no infection
Interstitial Cystitis
Type of cytitis foamy macrophages, Michaelis-Gutmann bodies
Malakoplakia.
acquired defects in phagocyte function. mostly by E. Coli or ocassional Proteus
Malakoplakia.
commonly as a result of instrumentation, including indwelling catheters
polypoid cytitis
Most common bladder neoplasms
urothelial carcinoma
nests of urothelium (von Brunn nests) grow downward into the lamina propria.
Cystitis glandularis and cystitis cystica
focal proliferation of the basal layer of
Von Brunn nests
Localized or diffuse metaplastic change of the urothelium in
response to chronic infection, calculi or prolonged
catheterization
Nephrogenic metaplasia
ninth most common cancer type
worldwide
Bladder cancer
Most common presentation of bladder cancer
Gross or microscoping hematuria
two distinct precursor lesions to invasive
urothelial carcinoma
noninvasive papillary tumors and flat noninvasive urothelial carcinoma in situ
Molecular pathways of Papillary tumors
FGFR3, RAS mutations
Molecular pathways of FLA T or CIS
TP53, RB mutation
most common symptom of bladder
cancer
Painless hematuria
Muscle-invasive bladder cancers are associated with what genes
inactivation of TP53 and RB tumor suppressor genes
Common cancer associated with schistosomiasis
Squamous cell carcinoma
Most common cause of bladder obstruction for female
Cystocele of the bladder
Most common cause of Nongonococcal urethritis
Chlamydia
inflammatory urethritis that is associated with arthritis, conunctivits and urethritis
reactive arthritis
inflammatory lesion that presents as
a small, red, painful mass about the external urethral meatus,
typically in older females
Urethral caruncle
more common congenital anomaly of the penis (usually ventral)
Hypospadias
Malformation of urethral groove dorsal canal
Epispadias
prepuce is too small to permit its normal retraction
phimosis.
Common Cause of phimosis
Balanoposthitis
Common agents of Balanoposthitis
C. Albicans
Gardnerella
Condyloma acuminatum is a benign sexually transmitted
wart caused by
human papillomavirus
low risk and less frequent HPV
HPV 6
most frequent HPV of Condyloma
HPV 11
lesion results in penile curvature
toward the side of the lesion and pain during intercourse.
cause by trauma
Peyronie Disease
Bowen disease and bowenoid papulosis are associated with what HPV
HPV16
older men, solitary lesion
Bowen disease
Bowen disease
penile shaft and scrotum of older men.
occurs in sexually active adults. It is
distinguished from Bowen disease by the younger age
of affected patients and its presentation as multiple (rather
than solitary) reddish brown papular lesions.
Bowenoid papulosis
associated with
poor genital hygiene and high-risk HPV infection.
Squamous cell carcinoma of the penis
What proteins can inactivate the p53 and RB tumor suppresor that found in HPV
E6 and E7 proteins
nonpainful until they undergo secondary
ulceration and infection
Invasive squamous cell carcinoma of the penis
Places with most common incidences of Squamous cell carcinoma
Africa, Asia and South america, with lower incidence of circumcision
complete or partial failure of the
intra-abdominal testes to descend into the scrotal sac
Cryptorchidism
what phase is the testis comes to lie within the lower abdomen or brim of the pelvis?
transabdominal phase
substance controlls the transabdominal phase
mullerian-inhibiting substance
what phase the testes descend through the inguinal canal into the scrotal sac?
Inguinoscrotal phase
Surgical correction of cryptorchid
orchiopexy
which testis have higher risk of malignancy
the descended one (contralateral)
What genetical disorder that can cause regression or atrophy of the testis
Klinefelter syndrome
Precursor lesion that can cause epididymitis
UTI
Most frequent sexually transmitted pathogens that can cause epididymitis
C. Trachomatis and N. gonorrhoeae
What kind of infarction is Testicular torsion causes
Hemorrhagic
Race with highest risk of Testicular Germ cell tumor
Northern Europe and New Zealand
What predisposing disorder that is associated with testicular germ cell tumor
Testicular dysgenesis syndrome and Klinefelter syndrome
What Serum Biomarker is produced by yolk sac tumor
AFP
What serum bio marker is elevated with mass tumor and asses the tumor burden
Lactate Dehydrogenease
Serum biomarker in syncytiotrophoblastic turmors
HCG
What is the most common Germ cell tumor
Seminoma
What decade is the peak incidence
4th
Microscopically has a fried egg appearance cells
Seminoma
Tumor of the testis that doesn't metasteszie and slow growing
Spermatocytic Tumor
Most common testicular tumors in infants up to 3 years of age
Yolk Sac Tumor
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