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Flashcards in Urology Deck (104)
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1

Ureteritis

Inflammation of ureters due to ascending infection from vesicoureteric reflux or descending kidney infections

- Intrinsic causes: calculi (urolithiasis), intraluminal blood clots, fibroepithelial polyps, inflammatory strictures, amyloidosis, tumors of ureter
- Extrinsic causes: Tumors (cervical cancer), pregnancy, endometriosis, aberrant renal vessels to lower pole of kidney

2

Urolithiasis

Formation of stones in collecting system of urinary tract

3

Nephrolithiasis

Stones in the collecting system of kidney.
- Due to urine concentration with precipitation of minerals
- Most are unilateral, usually in the calyces, renal pelvis, or bladder
- Presents with severe, abrupt flank pain, groin pain, fever, frequency, pain with urination (dysuria), and blood in the urine (hematuria)

Staghorn Calculi= large stones dilating renal pelvis, calices--> cast formation
(Struvite, cystine, uric acid stones)

Types of Stones:
1. Calcium stones= most common
- Calcium oxalate= due to hypercalciuria
- Acidic urine (low pH)
- Calcium oxalate stones are hard and dark
- Urinalysis: calcium oxalate crystals are colorless tetrahedra (envelope shape), oval or dumbbell shapes; polarizable
** seen in ethylene glycol poisoning (antifreeze)

2. Struvite stones= Magnesium ammonium phosphate (15% of stones)
- Due to urea-splitting bacteria (Proteus, Staphylococcus, Providencia)
- Alkaline urine (high pH)
- Triple phosphate crystals in urinalysis are colorless, rectangles or coffin lids shaped

3. Uric Acid stones= due to hyperuricemia (6% of stones)
- Radiolucent
- Acidic urine (low pH)
- Rhomboid crystals

4. Cysteine stones= due to genetic defects in cystine transport
- Autosomal recessive
- Yellow-brown radiopaque stones
- acidic urine (low pH)
- Crystals hexagonal

4

Hydronephrosis

Dilated renal cortex
- Most commonly caused by congenital obstruction of ureteropelvic junction in children
- Most common in males, < 6 months
- Left sided (23-30% bilateral)

5

Sclerosing retroperitoneal fibrosis

Ureteral obstruction due to dense fibrosis of retroperitoneal soft tissues and chronic inflammation
- Adults age 40-60
- Associated with drugs, autoimmunity
- can also be seen with Riedel thyroiditis, liver PSC, mediastinal fibrosis

6

Bladder exstrophy

Absence of anterior bladder wall, anterior abdominal wall
- May be associated with epispadias
- 1:3 M:F ratio

7

Bladder diverticula

Pouch-like evaginations of bladder wall
- Seen in males > 55 years
- Requires surgery when associated with infections, stones, perforation

8

Urachus

Vestigal structure connecting bladder dome to umbilicus in abdomen
- Can persist in adults, give rise to malignancies

9

Congenital incompetence of vesicoureteral valve

Abnormal junction between ureters, urinary bladder
- Ureters enter bladder perpendicularly (short intravesical segment--> does not prevent urine backflow during micturation
- More common in young firls
- Mostly asymptomatic, but can cause reflux pyelonephritis

10

Cystitis

Inflammation of the bladder.
– Clinically manifest as dysuria (pain or burning with urination), frequent urination including nocturia, urgency, hematuria and lower abdominal pain.

11

Bacteriuria

Bacteria colonization of urine without symptoms

12

Infectious cystitis

Most common UTI
Caused by:
- Fungal cystitis (candida)
- Schistosomiasis
- Viral cystitis: Adenovirus (type 11), HSV (hemorrhagic cystitis)
- Cyclophosphamide (give Mesna to reverse)
- Bacterial: e. coli, staph saprophyticus, klebsiella sp.

13

Interstitial cystitis

Painful bladder syndrome
- Persistent cystitis with pelvic pain and irritative voiding symptoms
• More frequently in females
• Multifactorial
• Cytoscopy: punctate hemorrhage or “Hunner ulcer”
• Diagnosis is of exclusion
• Overactive bladder is characterized by “urgency” of urination, pain is not the key feature but urine leakage
- Mucosal ulceration “Hunner ulcer” covered by fibrin and necrotic debris
• Inflammation, including mast cells, and later, a contracted bladder due to transmural fibrosis.

14

Malakoplakia

Malakos= Soft
Plax= plaque
- Papule, plaque, ulceration of GU tract
- Accumulation of macrophages
- 5-7th decades, females
- Associated with e.coli infection

Histo: Inflammation with large macrophages, eosinophilic cytoplasm with PAS stain

Michaelis-Gutmann bodies (calcifications)
- Engorged macrophage lysosomes with bacterial fragments (lysosomal defect)--> calcium salt deposition--> Michaelis Gutman bodies

15

Radiation cystitis

4-6 weeks post-radiotherapy
- Edema, chronic cystitis, ulcers, fibrosis

16

Brunn Buds and Nests

Type of benign urothelial lesion; associated with chronic inflammation, caliculi

Buds= Normal invaginations of surface urothelium into lamina propria

Nests= similar to buds, urothelial cells have detached from surface, seen within lamina propria

17

Cystitis Cystica

Type of benign urothelial lesion; associated with chronic inflammation, caliculi

Cystic dilation of Brunn nests (common)
- See eosinophilic, proteinaceous material in lumen
- Can also be seen in urethra/ureter

18

Cytstitis glandularis

Type of benign urothelial lesion; associated with chronic inflammation, caliculi

Differs from Cystitis Cystica only in the nature of lining cells--> mucin-secreting columnar epithelial cells

19

Squamous metaplasia of urothelium

transformation of urothelium to squamous mucosa: reaction to chronic injury and inflammation associated with calculi (50% normal adult women, 10% men)

20

Nephrogenic metaplasia

Lesion caused by transformation of urothelium into renal tubules
- Small tubules clustered in lamina propria--> exophytic nodule
- Lesions may result form implants of detached renal tubular cells carried downstream
- Can produced tumor-like protrusions that obstruct the ureters

21

Hypospadia

Urethra opens on underside of penis
- Incomplete closure of urethral folds of urogenital sinus
Non-complicated surgical repair

22

Epispadia:

RARE- Urethra opens on upper side of penis
- Can commonly see entire urethra open along entire shaft
Complicated surgical repair

23

Phimosis

Narrowing of prepuce--> impairs retraction over glans

Paraphimosis: narrow prepuce retracted, can strangulate glans (due to infection, trauma)
- Both cured by cirumcision

24

Scrotal massas

Hydrocele= serous fluid collection in scrotal sac between two layers of tunica vaginalis
- Congenital: most common cause of scrotal swelling in infants, associated with inguinal hernia
- Acquired: secondary to infection, tumor, trauma; U/S or transluminate fluid--> can lead to testicular atrophy or fluid can become infected and cause periorchitis

Hematocele: accumulation of blood between tunica vaginalis layers due to trauma, hemorrhage into hydrocele, tumor, infection

Spermatocele: Cyst in efferent ducts (widened) of rete testis or epididymis
- Ressembles paratesticular nodule or fluid-filled mass
- Cyst is lined with cuboidal epithelium with spermatozoa in various degenerative stages

Varicocele: Dilation of testicular veins
- Cause infertility, oligospermia (most asymptomatic)

Scrotal inguinal hernia: protrusion of intestines into scrotum through inguinal hernia

25

Priapism

Painful erection unrelated to sexual excitation
- Secondary to blood outflow blockage, hematologic disorders (sickle cell, polycythemia vera, leukemia), brain, spinal cord diseases

26

STDs causing painful lesions

Herpes: Most common STD of the glans; manifestsed as grouped vesicles, ulcerate--> crusts

Chancroid: Haemophilus Ducreyi
- Accompanied by inflammation of inguinal lymph node

27

STDs causing non-painful lesions

Syphillis: Solitary, soft ulcer

Granuloma inguinale: Klebsiella
- Donovan bodies: rod-shaped bacteria within histiocytes
- Tropical disease
- Ulcers enlarge, heal very slowly

Lymphogranuloma Venereum: Chlamydia trachomatis
- Swollen groin lymph nodes
- Sinuses drain pus and serosangoinous fluid from nodes

Condylomata Acuminata: HPV genital wart
- Hyper- and parakeratosis, koilocytes
- Warts on shaft, small polyps on glans

28

Inflammatory disorders of Penis

Balanitis: Glans, due to poor hygeine

Balanoposthitis: glans and foreskin; bacteria, fungi

Complications: meatal stricture, phimosis, paraphimosis

29

Balanitis Xerotica Obliterans

Chronic inflammatory syndrome of subepithelial connective tissue
Xerotica= fibrosis
Obliterans= sclerosis

Glans= white, indurated
- Can cause strictures, phimosis
Equivalent to lichen sclerosis atrophicus of vulva

30

Circinate Balanitis

Circular, linear, or confluent plaque-like discolorations of glans, superficial ulcerations
Seen in Reiter syndrome