40. Transitional cell carcinoma 41. Squamous cell carcinoma of the bladder - URINARY INCONTINENCE Flashcards Preview

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Flashcards in 40. Transitional cell carcinoma 41. Squamous cell carcinoma of the bladder - URINARY INCONTINENCE Deck (27):
1

Urinary incontinence - types

1. Stress incontinence
2. Urgency incontinence
3. Mixed incontinence
4. Overflow incontinence

2

Stress incontinence -mechanism

Outlet incompetnece ( urethral hypermodility or intrinsic sphincteric defiiciency ---> leak with high intra-abdominal pressure ( eg. sneezing, lifting)

3

Stress incontinence - increased risk with

obesity
vaginal delivery
prostate surgery

4

Stress incontinence - diagnosis

+ bladder stress test --> directly observed leakage from urethral upon coughing or Valsava maneuver

5

Stress incontinence - treatment

1. pelvic floor muscle strengthening ( Kegel) exercise
2. weight loss
3. pessaries ( a plastic device inserted into the vagina)

6

Urgency incontinence - mechanism

Overactive bladder ( detrusor instability ) --> leak with urge to void immediately

7

Urgency incontinence - treatment

1. pelvic floor muscle strengthening ( Kegel) exercise
2. bladder training ( timed voiding, distraction and relaxation techniques)
3. antimuscarinics

8

Mixed incontinence

features of both stress and incontinence

9

Overflow incontinence

incomplete emptying ( detrusor underactivity - weak to emoty the bladder or oultet obstruction _ --> leak with overfilling--> increased postvoid residual (urinary retention) on catheritirization or ultrasound

10

Overflow incontinence

catheriterization
relieve obstruction ( α- blockers for BPH)

11

Squamous cell carcinoma of the bladder - mechanism

Chronic irritation of urinary bladder --> squamous metaplasia --> dysplasia and squamous cell carcinoma

12

Squamous cell carcinoma of the bladder - clinical manifestations

painless hematuria

13

Squamous cell carcinoma of the bladder - risk factors

1. Schistosoma haematobium infenction ( Middle East)
2. Chronic cystitis
3. Smoking
4. Chronic nephrolithiasis

14

Schistosoma

1. S. haemotobium 2. S. mansoni 3. S. japonicum
transmission : snail are host cercarieae penetrate skin of humans
treatment : praziquantel

15

Schistosoma

Liver and spleen enlargement ( S. mansoni S. japonicum)
fibrosis and inflammation , portal hypertension
chronic infenction with S. haematobium --> SCC of the bladder and pulmonary hypertension

16

Mc tumor of urinary tract system

transitional cell carcinoma

17

Transitional cell carcinoma can occur in (location)

1. renal calyces
2. renal pelvis
3. ureters
4. bladders

18

Transitional cell carcinoma -manifestation

painless hematuria

19

Transitional cell carcinoma is associated with ... (risk factors)

1. Phenacetin
2. smoking
3. aniline dyes
4. cycophoshamide

20

phenacetin has declined because of

its adverse effects, which include risk of certain cancers and kidney damage

21

Transitional cell carcinoma - histology

1. Dysplastic urothelium
2. Fibroovascular core in papillary tumor

22

• In which four anatomic structures of the urinary tract can transitional cell carcinoma occur?

Renal calyces, renal pelvis, ureters, and bladder

23

• A smoker presents with painless hematuria and weight loss. Urine sediment is negative for casts. What diagnosis are you concerned about?

Transitional cell carcinoma of the bladder

24

• What exposures are associated with transitional cell carcinoma?

Phenacetin, Smoking, Aniline dyes, and Cyclophosphamide (problems in the Pee SAC)

25

• A Middle Eastern smoker presents with painless hematuria. What condition does he likely have?

Bladder squamous cell carcinoma (he has two risk factors: smoking and potential exposure to Schistosoma haematobium in the Middle East)

26

• Chronic urinary bladder irritation can lead to squamous metaplasia, which when not checked can eventually progress how (histologically)?

It could become squamous dysplasia, which predisposes to squamous cell carcinoma

27

• A patient has had recurrent kidney stones all of his life. He presents with painless hematuria. What diagnosis must you rule out?

Squamous cell carcinoma of the bladder (chronic nephrolithiasis is a risk factor)

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