Medical terminology terminology Of Of urinary system urinary system.
The Lower Urinary System and Male Genital System
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Transcript of The Lower Urinary System and Male Genital System
The Lower Urinary System The Lower Urinary System and Male Genital Systemand Male Genital System
The Lower Urinary TractThe Lower Urinary Tract
Congenital anomaliesCongenital anomalies
Ureteropelvic junction obstruction – most Ureteropelvic junction obstruction – most common cause of hydronephrosis in common cause of hydronephrosis in infants and children, boys>girls, 20% infants and children, boys>girls, 20% bilateralbilateral
Ureteral Obstructive LesionsUreteral Obstructive Lesions
IntrinsicIntrinsic
CalculiCalculi
StricturesStrictures
TumorsTumors
Blood clotsBlood clots
NeurogenicNeurogenic
ExtrinsicExtrinsic
PregnancyPregnancy
Periureteral Periureteral inflammationinflammation
EndometriosisEndometriosis
TumorsTumors
Sclerosing Retroperitoneal FibrosisSclerosing Retroperitoneal Fibrosis
Fibrous proliferative inflammatory process Fibrous proliferative inflammatory process encasing the retroperitonal structures and encasing the retroperitonal structures and causing hydronephrosiscausing hydronephrosis
Similar to Riedel thyroiditisSimilar to Riedel thyroiditis70% no identifiable cause ( Ormond disease)70% no identifiable cause ( Ormond disease)Drugs ( ergot derivatives, Beta blockers)Drugs ( ergot derivatives, Beta blockers)Adjacent inflammatory conditionsAdjacent inflammatory conditions (Crohn disease)(Crohn disease)Malignant disease ( lymphoma, UT carcinoma)Malignant disease ( lymphoma, UT carcinoma)
Urinary BladderUrinary Bladder
Congenital anomaliesCongenital anomalies
DiverticulaDiverticula
ExstrophyExstrophy
VURVUR
Patent urachusPatent urachus
CystitisCystitisBacterialBacterial
E. Coli, Proteus, Klebsiella, EnterobacterE. Coli, Proteus, Klebsiella, EnterobacterTBTBCandida, CryptococcalCandida, CryptococcalChlamydia, MycoplasmaChlamydia, MycoplasmaSchistomiasisSchistomiasisAdenovirusAdenovirus
Predisposing factorsPredisposing factorsFemale, calculi, urinary obstruction, DM, instrumentation, immune deficiencyFemale, calculi, urinary obstruction, DM, instrumentation, immune deficiency
TriadTriadFrequency, Lower abdominal pain, DysuriaFrequency, Lower abdominal pain, Dysuria
Special formsSpecial formsInterstitial – chronic pelvic painInterstitial – chronic pelvic painMalacoplakia – soft yellow, raised mucosal plaquesMalacoplakia – soft yellow, raised mucosal plaquesPolypoid – irritation to the bladder mucosaPolypoid – irritation to the bladder mucosaHemorrhagic- adenovirus, cyclophosphamideHemorrhagic- adenovirus, cyclophosphamideFollicular- aggregates of lymphocytesFollicular- aggregates of lymphocytesEosinophilic- nonspecific subacute infectionEosinophilic- nonspecific subacute infection
Metaplastic lesionsMetaplastic lesions
Cystitis cystica et glandularis- nests of Cystitis cystica et glandularis- nests of urothelium grow downward into lamina urothelium grow downward into lamina propriapropria
Squamous metaplasiaSquamous metaplasia
Nephrogenic adenoma – shed renal tubular Nephrogenic adenoma – shed renal tubular cells that implant in the urothelium in cells that implant in the urothelium in response to injuryresponse to injury
NeoplasmsNeoplasms
Urothelial ( transitional) tumorsUrothelial ( transitional) tumors
90% of all bladder tumors90% of all bladder tumors
Exophytic papillomasExophytic papillomas
Inverted papillomasInverted papillomas
PUNLMPs- papillary urothelial neoplasms of low PUNLMPs- papillary urothelial neoplasms of low malignant potentialmalignant potential
Low grade and high grade papillary urothelial Low grade and high grade papillary urothelial cancerscancers
CISCIS
EpidemiologyEpidemiology
Males> FemalesMales> FemalesCigarette smokingCigarette smokingIndustrial exposures to arylaminesIndustrial exposures to arylaminesSchistosoma infectionsSchistosoma infectionsLong-term use of analgesicsLong-term use of analgesicsLong-term exposure to cyclophosphamideLong-term exposure to cyclophosphamidePrior exposure to irradiationPrior exposure to irradiationChromosome 9 deletionsChromosome 9 deletionsClinical – painless hematuriaClinical – painless hematuria
UrethraUrethra
UrethritisUrethritis
GCGC
Chlamydia, Mycoplasma, Chlamydia, Mycoplasma,
Enteric organismsEnteric organisms
Reiter’s syndromeReiter’s syndrome
Urethral carbuncleUrethral carbuncle
Peyronie disease – subcutaneous fibrosisPeyronie disease – subcutaneous fibrosis
CarcinomaCarcinoma
Male genital tractMale genital tract
PenisPenishypospadiashypospadiasEpispadiasEpispadiasPhimosisPhimosisBalanoposthitisBalanoposthitisCondyloma acuminatumCondyloma acuminatumCISCISBowen disease – single erythematous plaqueBowen disease – single erythematous plaqueBowenoid Papulosis – multiple warty lesions, HPV 16Bowenoid Papulosis – multiple warty lesions, HPV 16Invasive Squamous cell carcinomaInvasive Squamous cell carcinoma
Testes and EpididymisTestes and Epididymis
Cryptorchidism- increased incidence of germ cell tumorsCryptorchidism- increased incidence of germ cell tumorsAtrophy and decreased fertilityAtrophy and decreased fertilityNonspecific epididymitis and orchitisNonspecific epididymitis and orchitisGranulomatous ( auto-immune) orchitisGranulomatous ( auto-immune) orchitisGCGCMumpsMumpsTBTBSyphilisSyphilisTorsion – bell clapper deformityTorsion – bell clapper deformityTunica VaginalisTunica Vaginalis
Hydrocele, Hematocele, Chylocele, Spermatocele, VaricoceleHydrocele, Hematocele, Chylocele, Spermatocele, Varicocele
Testicular TumorsTesticular TumorsGerm Cell tumorsGerm Cell tumors
Seminomas – very radiosensitive, most frequent, analogous to dysgerminoma in femalesSeminomas – very radiosensitive, most frequent, analogous to dysgerminoma in femalesSpermatocytic SeminomaSpermatocytic SeminomaEmbryonal carcinoma – second most common, painful, worse prognosisEmbryonal carcinoma – second most common, painful, worse prognosisYolk Sac tumorYolk Sac tumorChoriocarcinomaChoriocarcinomaTeratoma – almost always malignantTeratoma – almost always malignantMixed tumorsMixed tumors
Clinical featuresClinical featuresPainless enlargement of the testisPainless enlargement of the testisSpread via para-aortic nodes to medistinal and supraclavicularSpread via para-aortic nodes to medistinal and supraclavicularNSGCTs more aggressive , poorer prognosisNSGCTs more aggressive , poorer prognosisHCG, AFP, LDHHCG, AFP, LDH
Sex Cord-Gonadal StromaSex Cord-Gonadal StromaLeydig Cell – precocious pubertyLeydig Cell – precocious pubertySertoli Cell – no endocrineSertoli Cell – no endocrine
GonadoblastomaGonadoblastomaTesticular LymphomaTesticular Lymphoma
ProstateProstate
4 biologically and anatomically distinct 4 biologically and anatomically distinct zones:zones:
Peripheral – most carcinomasPeripheral – most carcinomas
CentralCentral
Transitional – most hyperplasiaTransitional – most hyperplasia
Anterior fibromuscular stromaAnterior fibromuscular stroma
Acute bacterialAcute bacterial Same organisms as UTIsSame organisms as UTIs
Fever, chillls, dysuria, Fever, chillls, dysuria, tender,boggy prostatetender,boggy prostate
Chronic bacterialChronic bacterial Recurrent UTIsRecurrent UTIs
Low back pain, abd Low back pain, abd discomfort, dysuriadiscomfort, dysuria
Chronic Chronic abacterialabacterial
Most common formMost common form
Negative cultureNegative culture
Leukocytes in fluidLeukocytes in fluid
GranulomatousGranulomatous BCG treatment for bladder BCG treatment for bladder cancercancer
Reaction to secretions from Reaction to secretions from ruptured ductsruptured ducts
ProstatitisProstatitis
Benign Prostatic HyperplasiaBenign Prostatic Hyperplasia
Nodular hyperplasiaNodular hyperplasiaVery common in men>50 Very common in men>50
years of ageyears of agePartial or complete Partial or complete
obstruction of urethraobstruction of urethraOverall reduction in the rate Overall reduction in the rate
of cell deathof cell deathDHT from stromal cellsDHT from stromal cells
induces growth factorsinduces growth factors
Bladder hypertrophy and Bladder hypertrophy and distensiondistension
Urine retentionUrine retentionFrequency, nocturia, Frequency, nocturia,
difficultystarting and difficultystarting and stopping stream, overflow stopping stream, overflow dribbling, dysuriadribbling, dysuria
Increased risk of infectionIncreased risk of infectionSudden acute urine Sudden acute urine
retention –emergency retention –emergency catherizationcatherization
Prostate TumorsProstate Tumors
AdenocarcinomaAdenocarcinomaMost common cancer in Most common cancer in
menmenAndrogens play an Androgens play an
important roleimportant roleFH importantFH important
BRCA2BRCA2Inflammation may set the Inflammation may set the
stagestage
TMPRSS2 promoter, ETS TMPRSS2 promoter, ETS genegene
Hypermethylation of Hypermethylation of GSTRP1GSTRP1
EZH-2EZH-2AMACRAMACRPCA3PCA3PSA – organ specific, PSA – organ specific,
velocity of changevelocity of change
Prostate TumorsProstate Tumors
PIN – high grade prostatic intraepithelial neoplasiaPIN – high grade prostatic intraepithelial neoplasia
Gleason score – 2 numeric grades added togetherGleason score – 2 numeric grades added together
Gritty and firmGritty and firm
Outer layer of basal cell layer is absent in Outer layer of basal cell layer is absent in carcinomacarcinoma
Grade and stage are best prognostic factorsGrade and stage are best prognostic factors
Boney metastases in vertebrae – universally fatalBoney metastases in vertebrae – universally fatal