Urological Pathology

Question 1

Renal cell carcinoma

Answer 1

Cancer of the kidney that arises from the renal tubular epithelium

Question 2

Epidemiology of renal cell carcinoma

Answer 2

Age >60
Male
PMH of obesity, smoking, NSAID use, ESRF and on dialysis
Family history (especially Von Hippel-Lindau)

Question 3

Paraneoplastic syndromes

Answer 3

Signs and syndromes not related to local effects of the primary or metastatic tumours (e.g. proteins/hormones secreted by tumour cells or immune cross-reactivity)

Question 4

Local primary tumour effects of RCC

Answer 4

Haematuria

(sometimes) Abdominal pain

Question 5

Paraneoplastic syndromes of RCC

Answer 5

Common in RCC!
Cachexia
Hypertension (from renin)
Polycythemia (from erythropoietin)

Question 6

Wilms’ tumour

Answer 6

Aka nephroblastoma
Cancer of the kidney that arises from nephroblasts
Occurs in children under 5
5-10% a/w genetic syndromes (Beckwith-Weidemann, WAGR, Denys-Drash)
90% unilateral

Question 7

Complications of macroglossia

Answer 7

Dysphagia
Airway obstruction
Speech problems

Question 8

Clinical features of Wilms’ tumour

Answer 8

+++ abdominal distension especially if bilateral
Haematuria
Mets are rare
Paraneoplastic syndromes are rare

Question 9

Urolithiasis

Answer 9

Renal stones
Classed by composition of stone
70% calcium
5% urate
1% cysteine
15% struvite (magnesium ammonium phosphate)

Question 10

Aetiology of calcium urolithiasis

Answer 10

Hypercalcaemia

Question 11

Aetiology of urate urolithiasis

Answer 11

Gout, malignancy (high cell turnover)

Question 12

Aetiology of cysteine urolithiasis

Answer 12

Congenital cystinuria

Question 13

Aetiology of struvite urolithiasis

Answer 13

UTI with urease production
Urease converts urea to ammonia
Ammonia causes pH rise
Precipitation of magnesium, ammonium and phosphate salts

Question 14

Clinical features of urolithiasis

Answer 14

Pain
If in ureter - ‘loin to groin pain’ (renal colic)
If in bladder - lower abdominal pain
If in urethra - dysuria
N.B. X-ray does not eliminate stone possibility due to radiotransparency of irate stones

Question 15

Complications of urolithiasis

Answer 15

Obstruction = hydronephrosis +/- hydroureter = renal impairment
Urinary stasis = infection
Local trauma = squamous metaplasia = SCC risk

Question 16

Vesicoureteral reflux (VUR)

Answer 16

When urine flows backwards from the bladder to ureter

Question 17

Epidemiology of VUR

Answer 17

Affects 10% of population
Young people, especially age < 2
Those with a family history of VUR

Question 18

Aetiology of VUR

Answer 18

Congenital abnormality of vesicouretic junction - fails to close when bladder wall contracts

Question 19

Clinical features of VUR

Answer 19

Usually asymptomatic

Most children grow out of it

Question 20

Complications of VUR

Answer 20

Stasis = UTI

Back pressure and ascending infection = renal damage

Question 21

Urothelial carcinoma

Answer 21

Aka transitional cell carcinoma
Cancer arising from urothelium
Accounts for >90% of bladder cancer

Question 22

Epidemiology for urothelial carcinoma

Answer 22

Adults aged >60
Male
Smokers
Exposure to certain industrial chemicals (dye, rubber)
Family history
Treatment for previous cancer (pelvic radiotherapy, cyclophosphamide)

Question 23

Clinical features of urothelial carcinoma

Answer 23

Haematuria
Frequency, urgency, dysuria
Urinary obstruction
Can get lung, bone and liver mets
Paraneoplastic syndromes are rare
50% 5 year survival but improving due to radical surgery

Question 24

Neurogenic bladder

Answer 24

Inability to properly empty the bladder due to neurological damage
Spastic: if damage to brain or spinal cord
Flaccid: if damage to peripheral nerves

Question 25

Epidemiology of neurogenic bladder

Answer 25

All genders and ages - depends on cause

Question 26

Aetiology of neurogenic bladder

Answer 26

UMN/spastic neurogenic bladder: stroke, MS, spinal injury | LMN/flaccid neurogenic bladder: pregnancy, diabetes, alcohol (B12 deficiency)

Question 27

Clinical features of neurogenic bladder

Answer 27

Symptoms related to lack of control of bladder emptying e.g. urinary retention, abdominal distention, incontinence, urge, frequency

Question 28

Complications of neurogenic bladder

Answer 28

Stasis - UTI Stasis - Urinary stones Inability to empty bladder - bladder distention, hydroureter, hydronephrosis, renal function impairment, oedema etc.

Question 29

Benign prostatic hyperplasia

Answer 29

Increased number of both stromal and glandular cells in the prostate Known by patients as enlarged prostate

Question 30

Epidemiology of benign prostatic hyperplasia

Answer 30

``` Old men (20% by age 40, 70% by age 60) Obesity, diabetes, FH ```

Question 31

Clinical features of benign prostatic hyperplasia

Answer 31

``` LUTS (lower urinary tract symptoms) Hesitancy or urgency Poor/intermittent stream Straining Prolonged micturition Incomplete bladder emptying Frequency Incontinence Nocturia ```

Question 32

Prostatic adenocarcinoma

Answer 32

Cancer of the glandular epithelium in the prostate

Question 33

Epidemiology of prostatic adenocarcinoma

Answer 33

Old men Black men Family history (including BRCA1/2) Pesticide exposure

Question 34

Clinical features of prostatic adenocarcinoma

Answer 34

Lower urinary tract symptoms | Can metastasise to bone

Question 35

Cryptorchidism

Answer 35

``` Undescended testis (testis is not in scrotum) Types based on site of testis ```

Question 36

Epidemiology of cryptorchidism

Answer 36

In 3% of full term babies Much more common in premature babies More common with Down's syndrome or Kleinefelter syndrome (XXY male)

Question 37

Aetiology of cryptorchidism

Answer 37

Multifactorial | Often no cause identified

Question 38

Pathogenesis of cryptorchidism

Answer 38

Embryological failure of descent 7 weeks - testes begin to form 10-15 weeks - trans abdominal descent 25-35 weeks - inguinoscrotal descent

Question 39

Clinical features of cryptorchidism

Answer 39

``` Empty scrotum (10% bilateral) May resolve spontaneously ```

Question 40

Complications of cryptorchidism

Answer 40

Infertility Hernias Testicular cancer risk Testicular torsion

Question 41

Seminoma

Answer 41

Malignant neoplasm of the testis arising from germ cells in the seminiferous tubules Most common type of testicular cancer

Question 42

Epidemiology of seminoma

Answer 42

Young men (25-45) Family history Cryptorchidism (EVEN IF IT WAS SURGICALLY CORRECTED OR ONLY AFFECTED OTHER TESTIS)

Question 43

Clinical features of seminoma

Answer 43

Testicular lump, swelling, pain Can give lung mets and LN mets Can cause gynecomastia 95% 5 year survival

Question 44

Presentation of urinary tract obstruction

Answer 44

Symptoms of causative factor (many possibilities) plus... If complete obstruction - anuria, pain If partial obstruction - often asymptomatic

Question 45

Complications of urinary tract obstruction

Answer 45

Irreversible renal impairment or secondary VUR (due to back pressure) Infection or calculi formation due to urinary stasis