Pathology of urethral tract

Question 1

What epithelium lines the bladder?

Answer 1

Transitional epithelium

Question 2

What can cause cystitis?

Answer 2

Infection
Parasites
Aseptic
Reactive to catheters

Question 3

How does schistosomiasis infection lead to cancer?

Answer 3

Persistent inflammation
Results in keratinizing squamous metaplasia
Eventual squamous cell carcinoma

Question 4

What can cause persistent inflammation in the bladder?

Answer 4

Schistosomiasis

In-dwelling catheters

Question 5

What is aseptic cystitis?

Answer 5

Persistent symptoms of dysuria
Persistently negative cultures and urinalysis
Caused by a hypersensitivity reaction

Question 6

What is cystitis cystica?

Answer 6

Descriptive term of long term inflammation
Infolding of bladder mucosa into cysts
Reactive phenomenon

Question 7

What can can result for diverticula in the bladder?

Answer 7

Stagnant urine
Infection
Stones
Cancer

Question 8

What will result from bladder obstruction outflow?

Answer 8

Prostatism
Bladder muscle works hard and becomes trabeculated
Eventual persistent back pressure
Can undergo hypertrophy or hyperplasia

Question 9

What is the end point of urinary tract obstruction?

Answer 9

Hydronephrosis - dilation of collecting ducts and atrophic parenchyma

Question 10

What are risk factors for transitional cell carcinoma of the bladder?

Answer 10

Smoking ++++

Beta naphthylamine in the dye industry

Question 11

What does a transitional cell carcinoma look like?

Answer 11

Papillary with finger like projections

Carcinoma in situ is flat

Question 12

What will allow adenocarcinoma of the bladder to occur?

Answer 12

Background of metaplasia

Difficult to distinguish from a colon cancer that has invaded through

Question 13

What does urachal adenocarcinoma result from?

Answer 13

Remnant of the allantois

Forms dome of bladder to the umbilicus which usually involutes

Question 14

What is the function of the prostate gland?

Answer 14

Secretes prostatic fluid and fluid from seminal vesicles

Contractile function during ejaculatioin

Question 15

What part of the prostate gland does the seminal vesicle pass through?

Answer 15

Central zone

Question 16

What part of the prostate does the urethra pass through?

Answer 16

Transitional zone (area for PBH)

Question 17

What part of the prostate is prostate cancer most commonly found in?

Answer 17

Peripheral zone

Question 18

How can BPH be treated?

Answer 18

Transurethral resection of prostate

Alpha blockers

Question 19

How is prostate cancer diagnosed?

Answer 19

Transrectal biopsy

PSA

Question 20

What grading system is used for prostate cancer?

Answer 20

Gleason grading system - lowest grade is 6, highest is 10

Question 21

What can cause a high PSA?

Answer 21

Big prostate (BPH)
Prostatitis
PR exa
Spironolactone
Vigorous exercise
Ejaculation

Question 22

What is the clinical presentation of prostate cancer?

Answer 22

Lower urinary tract symptoms
Haematuria/ hematospermia
Bone pain
Anorexia
Wt loss

Question 23

What will prostate cancer feel like upon PR exam?

Answer 23

Asymmetrical
Nodular
Fixed and craggy

Question 24

What is PSA?

Answer 24

Glycoprotein enzyme produced by the secretory epithelial cells of the prostate gland
Involved in liquefaction of semen

Question 25

What type of cancer affects the prostate?

Answer 25

Adenocarcinoma

Question 26

Where does prostate cancer commonly spread to?

Answer 26

Pelvic lymph nodes | Skeleton - sclerotic lesions

Question 27

What are the broad classifications of prostate cancer?

Answer 27

T1-2 N0 M0 = organ confined disease T3-4 N0 M0 = locally advanced disease N+ M+ = metastatic disease

Question 28

What is the management for organ-confined disease?

Answer 28

Watchful waiting Active surveillance Radical surgery Radical radiotheapy

Question 29

What are complications of radical prostatectomy?

Answer 29

ED Incontinence Bladder neck stenosis

Question 30

What is the treatment for locally advanced disease?

Answer 30

Radiotherapy with neoadjuvant hormonal therapy

Question 31

What hormonal therapy is used in metastatic disease?

Answer 31

LHRH analogues | Anti-androgens

Question 32

What is the growth of prostate cancer cells under the influence of?

Answer 32

Testosterone and dihydrotestosterone

Question 33

What should you do if someone over 40 present with frank haematuria?

Answer 33

Flexible cystoscopy and CT urogram

Question 34

Where will lymph from the ureter drain?

Answer 34

Lumbar and iliac nodes

Question 35

Where will lymph from the testes drain?

Answer 35

Lumbar nodes

Question 36

Where will lymph from the superior bladder drain to?

Answer 36

Lumbar nodes

Question 37

Where will lymph from the kidneys drain to?

Answer 37

Para-aortic | Pre-aortic nodes