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This Concept Map, created with IHMC CmapTools, has information related to: Lower Urinary Tract, Lower Urinary Tract Urinary Bladder Inflammations-CYSTITIS -can->pyelonephritis Clinical-FREQUENCY, ABD PAIN, DYSURIA -all have the triad -fever, chills, malaise unusually Tx-treat primary disease, Lower Urinary Tract Urethra Inflammations URETHRITIS GONOCOCCAL-soon after infx NONGONOCOCCAL-common -E.coli, Chlamydia, Ureaplasma urealyticum Men-acc'd by prostatitis -Chlamydia-25-60% Nongono Women-acc'd by cystitis -Chlamydia-20% Nongono Clinical-pain, itching, frequency REITER SYNDROME- triad-ARTHRITIS, CONJUNCTIVITIS, URETHRITIS, Inflammations-CYSTITIS -can->pyelonephritis Clinical-FREQUENCY, ABD PAIN, DYSURIA -all have the triad -fever, chills, malaise unusually Tx-treat primary disease CHRONIC -persistent infx-fibrosis -heaped-up epith -Follicular cystitis-lymphoid follicles w/in muc -Eosinophilic cystitis-w/ eos, fibrosis, giant cells, Lower Urinary Tract Urinary Bladder MESENCHYMAL TUMORS Benign-rare -most common-leiomyoma -isolated, encapsulated, oval -rarely pedunculated Sarcomas-very uncommon -large masses into lumen -Rhabdomyosarcoma- -Adult form ᡠyo -Embryonal (Sarcoma Botryoides) -infancy, childhood -sim to femal GU tract, Inflammations-CYSTITIS -can->pyelonephritis Clinical-FREQUENCY, ABD PAIN, DYSURIA -all have the triad -fever, chills, malaise unusually Tx-treat primary disease ACUTE E.coli, Proteus, Klebsiella, Enterobacter, Tuberculous cystitis after renal TB C. albicans, crytococcal agens (esp in immunosuppressed) Schistosomiasis in Middle East Adenovirus, Chlamydia, Mycoplasm Can be ULCERATIVE or SUPPURATIVE HEMORRHAGIC CYSTITIS via: CTX-cyclophosphamide Radiation cystitis from XRT Adenovirus, Lower Urinary Tract Urinary Bladder Congenital Anomalies DIVERTICULA-mostly acquired from urethral obstruction (BPH) -stasis->infx, calculi, reflux EXSTROPHY-failure of ant. abd wall -can ->colonic metaplasia, infx ->stratified squamous -increase risk of adenoCA Tx-surgical correction VESICOURETERAL REFLUX -most common, most serious VESICOUTERINE FISTULAS PERSISTENT URACHUS -if not totally open, can have infx -can->URACHAL CYSTS -can->colonic adenoCA, Lower Urinary Tract Urinary Bladder SQUAMOUS CELL CA-70% die w/in 1yr -3-7% in US -more freq w/ schisto -irritation/infx -more frequently mixed w/ uroth ADENOCA-rare, can be mixed -urachal remnants -intestinal metaplasia -also small cell CA, signet-ring CA, Lower Urinary Tract Urinary Bladder UROTHELIAL TUMORS - MALE 50-80yo Papillomaə% Carcinoma in situ-flat, reddened-on mucosa Grade I-low malig potential-like papilloma -some cellular atypia, but well-diff'd Low-Grade(II)-1/2-papillary, non-invasive -can have recurrences after excision -still transitional cells-more layers -mitoses High-Grade(III)-1/2-pap, nodular or both -aneuploid, chrom/gene ABNLities -can mets(40%)- 60% mort in 10 yrs -more anaplasia, can look like SqCC -INVADE!, can be fung, necrotic, ulcerative -17q deletions-p53 RISKS-CIGARETTE SMOKING, arylamines, Schistosoma haematobium, (egypt, sudan), long-term analgesic use, long-term cyclophosphamide GENETICS-CHROM 9 del/muts-p16 tumor-supp -chrom 14 for flat lesions CLINICAL-PAINLESS HEMATURIA -can have freq, urgency, dysuria -can have pyelonephritis, hydronephrosis -often recur (any grade)-can be worse Better Px-tumors cells w/ A,B,H Ags Tx-early detection, adequate F/U, Lower Urinary Tract Urethra Tumors URETHRAL CARUNCLE -small, red, friable, painful mass FM-around ext. ureth meatus -older pts -young, fibroblastic CT, WBCs, vasc'ised -Tx-surgical excision PAPILLOMAS -just w/in or on ext meatus -viral? CA of URETHRA-uncommon -OLD WOMEN -near ext meatus -warty, papillary-early-sessile look ->later-fungating, ulcerating -mostly SqCC -urothelial protrudes from meatus -more AGGRESSIVE than bladder -death w/in a few years, Lower Urinary Tract Ureters Inflammation URETERITIS-part of UTI -infrequent clinical problems Ureteritis follicularis-fine gran. mucosal surface -due to subepith lympho accums Ureteritis cystica-fine cysts -can aggregate-grapelike -modified urothelial lining, Lower Urinary Tract Urinary Bladder SECONDARY TUMORS -mets mostly by direct extension -cervix, uterus, prostate, rectum ->hemorrhage, ureteral obstruction, vesicovaginal fistula, Lower Urinary Tract Urinary Bladder OBSTRUCTION -Male-prostatic enlargement -BPH or CA -Female-less common -cystocele MORPH-early-wall thickens (hypertrophic sm. mm) ->greatly enlarged sm mm ->trabeculations ->crypts, diverticula If Acute obstruction- -wall stretches, but still thin, Lower Urinary Tract Ureters Congenital or Acquired: DIVERTICULA-uncommon ->stasis, 2ndary infx HYDROURETER-dilation, elongation, and tortuosity -when congenital-due to abnl innerv. ->megaloureter-massive enlargement, Lower Urinary Tract Ureters Congenital Anomalies DOUBLE, BIFID URETERS -drain thru one orifice URETEROPELVIC JCN OBSTRUCTION ->hydronephrosis -boys, left ureter -adults-more in women, unlateral -due to ABNL sm. mm organization, excess collagen in stroma, extrinsic compression by vessels, Lower Urinary Tract Ureters Obstructive Lesions -stones, strictures, tumors, neuro, blood clots, baby, periureteral inflammation, endometriosis SCLEROSING RETROPERIT FIBROSIS -fibrous, prolif inflam retroperitoneal -encases structures ->hydronephrosis -middle-late age -ergot derivs, beta-blockers, inflam dzs (Crohn's, etc), malignancy -70% idiopathic-maybe autoimmune?, Lower Urinary Tract Ureters Tumors, Tumor-like Lesions PRIMARY-rare-50-60s -similar to other urothelial CA -obstruct lumen -often w/ other uroepith sites METS more common Benign Tumors of mesenchymal origin FIBROEPITHELIAL POLYP -small mass into lumen -in left>right -ureter>bladder, pelvis, urethra LEIOMYOMA, Inflammations-CYSTITIS -can->pyelonephritis Clinical-FREQUENCY, ABD PAIN, DYSURIA -all have the triad -fever, chills, malaise unusually Tx-treat primary disease CHRONIC CYSTITIS GLANDULARIS, CYSTICA -Brunn nests (urothelium) into lamprop ->transform to cub/col cells -line slit (GLANDULARIS) -OR cystic space (CYSTICA) -filled w/ clear fluid -uroth or cub lining -like ureteritis, pyelitis cystica -MORPH-intestinal metaplasia w/ goblet cells -w/ more metaplasia->AdenoCA, Inflammations-CYSTITIS -can->pyelonephritis Clinical-FREQUENCY, ABD PAIN, DYSURIA -all have the triad -fever, chills, malaise unusually Tx-treat primary disease CHRONIC INTERSTITIAL CYSTITIS - WOMEN -persistent, painful, chronic -inflam, fibrosis of all wall layers -PAIN, FREQ, DYSURIA, HEMATURIA -no evidence of infx some w/ HUNNER ULCERS-muc ulcers -mast cells prominent -autoimmune? ass'd w/ SLE, etc., Inflammations-CYSTITIS -can->pyelonephritis Clinical-FREQUENCY, ABD PAIN, DYSURIA -all have the triad -fever, chills, malaise unusually Tx-treat primary disease CHRONIC MALAKOPLAKIA-E.coli, Proteus -in immunosupp'd, defective degradation -plaques -foamy macs, giant cells, lymphos -PAS+ granules in macs -Michaelis-Gutmann bodies -laminated, mineralized in macs, b/w cells