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Flashcards in The Lower UT and Male Repro System Deck (43):

What causes Exstrophy of the bladder

Incomplete resorption of the anterior cloacal membrane which is nomrlaly replaced by smooth muscle in embryogenesis


What can failiure of the urachus to involute lead to ?

Vesicle-umbilical fistula or urachal diverticulum


What cancer is likely to develop from exstrophy of the bladder?

Squamous Carcinoma (from squamous metaplasia of exposed bladder mucosa)


What complications result form Nodular Prostatic Hyperplasia?

UTI from retention of urine in the bladder

Bladder Diverticula

Bladder stones from retained urine in a diverticulum becoming infected


Bladder Infection Risk is increased with what?

Bladder Calculi
Bladder Outlet Obstruction
Prior instrumentation or catheterization
Radiation therapy


What microscopical findings are associated with acute cystitis?

Stromal edema
Neutrophlic infiltrate of variable intensity


What is typical presentation of urothelial cell carcinoma?

Sudden Hematuria
less frequently, Dysuria


What is typical presentation of chronic cystitis?

Dysuria (pain when urinating)
Excessive urinary frequency
Lower abdominal or pelvic discomfort

Microscopic: Predominance of lymphocytes and fibrosis of the lamina propria


Describe an Exophytic Papilloma

Papillary fronds that are lined by urothelial epithelium (indistinguishable from normal urothelium)

Usually a single lesion 2-5 cm in diameter, although multiple papillomas are not unusual



RED VELVETY FLAT PATCHES (close to expohytic papillary urothelial cell carcinoma)


What are the most important risk factors for bladder cancer?

Cigarette Smoking
Industrial Exposure to Azo Dyes
Infection with Schistosoma Haematobium
Drugs (Cyclophosphamide and analgesics)
Radiation Therapy (prostate, cervical, rectal cancer)


What is hydrocele associated with in infants? adults?

Infants- Inguinal Hernia
Adults0 Infection, Tumor, or Trauma


What can cause Hematocele?

Testicular Tumors

Can develop into hydrocele


What does "field effect" refer to in regards to urotthelial cell carcinoma?

The etiologic factors associated with epithelial tumors of the renal pelvis and ureter are similar to those observed in bladder cancer


How does Rhabdomyosarcoma typically of the embryonal type manifest?

Mostly in children as SARCOMA BUTYROIDES

These are edematous, mucosal, polypoid masses that resemble a "cluster of grapes"


What are Urethral Caruncles? Which patients are affected

Polylpoid inflammatory lesions containing acutely and choronically inflamed granulation tissue, ulceration, and hyperplasia of urothelial or squamous epithelium.

The lesion is usually near the urethral meatus and produces pain and bleeding

The polypoid mass is exophytic, often ulcerated

This is mostly seen in women, mostly after menopause


How is the pronosis of squamous cell carcinoma of the bladder?

Poor- almost all patients with this tumor demonstrate invasion of the bladder wall at the time of initial presentation


What lesions develop from HPB?

Wart-like lesions- referred to as VERRUCAE and CONDYLOMATA

Lesion shows epidermal hyperkeratosis, parakeratosis, acanthosis, papillomatosis


What causes Balanoposthitis?

It is caused by bacterial infection, but in immunosuppressed persons and in diabeetics, it can also be caused by fungi. It is a typically a consequence of poor hygiene in uncircumcised men.


What are complications of Balanoposthitis?

- Stricture of the meauts, phimosis, and paraphimosis
- Phimosis


What is Phimosis? Paraphimosis?

The orifices of the prepuce may be too narrow to allow retraction over the glans penis.

When the narrow prepuce is forcefully retracted, it may strangulate the glans and impede the outflow of venous blood.


What are is the pathogenesis of BPH?

Mostly due to age0related changes in circulatingl evels of testosterone and dihyrotestosterone.

approximately 75% of men 80yo + have some degree of BPH


What is the typical presentation of Epididymitis?

Intrascrotal pain and tenderness, with or without associated fever


What is associated with Female Pseudohermaphroditism?

Virilization of the external genital organs

Virilization of Vulva: Fusion into scrotal folds and is associated with clitoromegaly (most often seen in adrenogenital syndrome caused by 21-OHase deficiency- also adrenal hyperplasia and ambiguous genitalia is seen with this deficiency)


What characterizes Male Psuedohermaphroditism? When does this normally occur?

- A normal 46, XY karyotype
- Gonads are cryptorchid testes, but the external genital organs appear feminine or ambiguously female, with signs of virilization

Most often encountered in androgen-insensitivity syndromes due to a congenital deficiency of the androgen receptor, also known as testicular feminization syndrome.


What is most common testicular tumor in the first 4 years of life? 4-12 yrs of life? Adults?

60yo): Malignant Lymphoma


What is the microscopic appearance of a Yolk sac tumor?

- Interlacing strands of epithelial cells surrounded by loose connective stroma
- Lobular arrangement of cells, surrounded by empty spaces, leads to the formation of glomeruloid structures referred to as Schiller-Duval bodies


What cancer secretes hCG?



Describe a Seminoma on gross exam? micro?

Gross: Solid, rubbery-firm masses
Micro: Neoplastic cells arranged as nests or sheets that are separated by fibrous septae and infiltrated with chronic inflammatory cells (lymphocytes, plasma cells, and macrophages)


What pathology is seen with Mumps Infection?

Orchitis in males
Testicular Pain and Gonadal swelling (most commonly unilateral)


What is Klinefelter Syndrome?

Cause: Meiotic Nondisjunction during oogenesis

Patients have 47 , XXY karyotype (1 in 25 patients have 4, XX) and are infertile

Patients typically have testicular atrophy and loss of meiotic and postmeiotic germ cells. Patients also have hypoandrogenism


Where does early nodular hyperplasia of the prostate begin ?

In the region of the proximal urethra (the urothelial zone)

In well-developed cases, the normal prostate gland is limited to an attenuated rim of tissue beneath the capsule


What is the most frequently diagnosed cancer in American men? Describe its histopathology

Prostatic Adenocarcinoma

Prostatic ducts lined by atypical (dysplastic) epithelial cells and a diminution in the number of basal cells.


What is Leuprolide Acetate?

A Gonadotropin Release inhibitor (used in prostate cancer treatment- tumor cells are androgen dependent)


What is Malakoplakia?

A rare inflammatory disorder of uknown etiology characterized by the accumulation of macrophages- with abundant eosinophilic cytoplasm containing PAS -positive granules. These macrophages exhibit laminated, basophilic calcospherite stermed Michaelis- Gutmann bodies.. Sofy yellow plaques on the mucosal surface of the bladder is common.


What PMH is associated with MALAKOPLAKIA?

It is often associated with an infection of the urinary tract by E. coli.

It is commonly seen in patients with a PMH of chronic infections, cancer or immunosuppression.



Foci of Cystitis Glandularis or
Intestinal Metaplasia or
Remnants of Urachal Epithelium in the bladder dome.


What is usual etiology of Squamous cell carcinoma of the bladdder?

Develops in foci of squamous metaplasia , usually due to shistosomiasis


What is a Hunner Ulcer?

Mucosal ulceration often seen in middle-aged women who suffer from chronic interstitial cystitis that features transmural (mucosa and muscularis affected) inflammation (increased mast cell number and fibrosis) of the bladder wall.


What are common symptoms of chronic interstitial cystitis/

Long-standing suprapubic pain, frequency, and urgency, with or without hematuria


What does scrotal swelling or enlargement usually indicate?

Abnormalities of testicular, epididymal, or scrotal development

(it is often seen in children but it can be seen in adults)


What is a spermatocele?

a cyst formed from the protrusions of the widened efferent ducts of the rete testis or epididymis. It manifests as a hilar paratesticular nodule or as a fluctuating mass filled with milky fluid containing spermatozoa in variety of stages of degeneration


Where does Embryonal Carcinomas invade?

The testis, epididymis, blood vessels

Then metastasizes to abdominal lymph nodes, lungs, and other organs.