Ureter, Urinary Bladder, and Urethra Study Notes Intro - the urothelium is the transitional epithelium designed to cover surfaces which change their areas rapidly - when transitional epithelium turns to transitional cell papilloma-carcinoma, it tends to do so in multiple places - a stricture is a fibrous tissue partially or totally occluding the lumen of a hollow organ, usually the ureter or urethra, usually post-inflammatory scarring Ureter Problems - acute obstruction causes renal colic - chronic obstruction is usually asymptomatic, though the kidney won't function and will eventually atrophy - places where stones hang-up are 1) the pyelo-ureteric junction; 2) the pelvic brim; 3) the ureterovesical junction - double ureter is whole or partial duplication, with two pelvises in the kidney - any obstruction to urinary flow during fetal life will result in cystic dysplasia of the portion of the kidney that isn't being properly drained - an incompetent ureterovesical valve is a common birth defect which causes reflux and predisposes to kidney infections - hydroureter (dilated ureter) can be causes by congenital, pregnancy, obstruction, or Chaga's disease - almost all cancer of the ureter is transitional cell carcinoma - there is a tendency to arise multifocally over the urothelium Benign Disease of the Urinary Bladder - exstrophy of the urinary bladder results from failure of the pubis to form properly - persistent urachus results in urine dribbling out hte navel; urachal cysts remain, and these are supposedly breding-ground for adenocarcinoma of the bladder - cystocele is drooping of a portion of the urinary bladder downward into the caudal areas of the pelvis - hypertrophy of the bladder wall results from obstruction, usually from prostatism - diverticula of the bladder may be congenital, but more often result from a portion of the mucosa pooching out between two strands of hypertrophied muscle in a person suffering from chronic obstruction; this may produce the famous double urination, and/or a place for stasis, inviting infection, and/or a place where bladder stones can form - bladder stones usually result from infection, and are composed of magnesium ammonium phosphate - cystitis is usually of bacterial origin, and has the same story as common pyelonephritis, which it preceeds - chemotherapy cystitis results from cyclophosphamide or busulfan administration, and radiation to the pelvic area can also produce a viciuos cystitis - Hunner's interstitial ulcerative cystitis is a poorly understood process in which all three layers of the bladder become chronically inflammed; pts are most commonly women, and they often have considerable pain and urgency - Malakoplakia is a curoius macrophage-rich response to proteus infections; the cells seem to have some problem phagocytizing the bugs - squamous metaplasia usually results from infestation with S. hematobium; this is a terrible public health problem, and the bladder can be ruined by all the eggs in the muscularis propria - dysplasia of the urothelium is relatively common if you search for it - don't forget amyloid and amyloidoma as causes of hematuria Bladder Tumors - hyperplasia of transitional epithelium is present when it is >6 or 7 or 8 cells thick - papillomas grow like seaweed, and are covered with normal transitional epithelium; unless they bleed, you'll never know they're there - transitional cell carcinoma is the usual bladder cancer of older adults - low-grade transitional cell carcinomas tend to assume a papillary growth pattern, and turn invasive only after a many years - high-grade transitional cell carcinomas tend to be invasive when discovered, and to progress rapidly to death; bladder discomfort, painless hematuria, and infection are typical presentations - carcinoma in situ of the bladder is defined to be replacement by highly anaplastic cells which have not invaded; usually asymptomatic, it may be uncomfortable if it allows backleak of electrolytes, since the salty urine stimulates pain fibers in the submucosa; around half of known cases of carcinoma in situ turn into cancer within five years - risk factors for transitional cell carcinoma include cigarette smoking, exposure to certain chemicals, abuse of phenacetin, cyclophosphamide, and kinks in tryptophan breakdown - adenocarcinoma of the bladder is uncommon; it arises where the urachus used to be, high on the front of the bladder, or else from cystitis glandularis - squamous cell carcinoma of the bladder usually arises in squamous metaplastic epithelium, the pt has schistosomiasis; this is the great cancer menace in Egypt, and it is extremely aggressive and lethal - pheochromocytoma - urinating turns from a pleasure to a headache Urethra - pts complaining of urethritis symptoms need to be questioned about consumption of jalepino peppers - posterior stricture - a man's problem; often congenital - urethral caruncle - a woman's problem, often developing late in life; an uncomfortable lesion with the gross and histologic appearance of a pyogenic granuloma