Urology: Bladder & prostate pathology (CP1 Standard)

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  • Created by: NDumps97
  • Created on: 27-03-19 10:26
What is the most common type of bladder tumour accounting for ~90% of cases?
Transitional Cell Carcinoma
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What is transitional epithelium?
Transitional epithelium is a type of stratified epithelium. This tissue consists of multiple layers of epithelial cells which can contract and expand in order to adapt to the degree of distension needed.
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Transitional epithelium lines the bladder - and where else?
Renal calyces, pelvis, ureter, and urethra - effectively the urinary system: therefore is known as urothelium.
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Transitional Cell Carcinoma (TCC) mostly occurs in the bladder. How might it present?
Painless haematuria, recurrent UTIs, voiding symptoms (symptoms when you empty the bladder: frequency, irritability etc)
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Name 3 risk factors for a bladder TCC
Smoking, chronic cystitis (inflamm of bladder), schistosomiasis, aromatic amines (rubber industry)
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How can cancers change the make-up of urine?
They may cause sterile pyuria
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What is sterile pyuria?
Pyruia (increased WBCs in the urine) but sterile on culture means there may be no bacteria isolated.
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What would done to definitively diagnose TCC? What investigationwould be used to assess potential spread of the cancer?
Cytoscopy with a biopsy taken is used to diagnose. CT (or MRI, lymphagiography) used to assess spread.
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What is bladder outlet obstruction? Name a cause of BOO which may occur within the bladder itself.
When urine flow out the base of the bladder is obstructed. e.g. Bladder tumour
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Causes of bladder outlet obstruction can occur outside the bladder too. Define: 'mural' with regards to BOO and name some 'mural' causes of BOO.
Mural = within the 'walls' of the urinary system, e.g. urethral stricture, structrual abnormalities neuropathic bladder (nerve damage means bladder doesn't constrict properly).
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Define 'extramural' with regard to BOO and name 2 extramural causes of bladder outlet obstruction
This means the obstruction is coming externally from the urinary tract - e.g. benign prostatic hyperplasia, prostatic carcinoma, paraphimosis, phimosis.
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What is phimosis and paraphimosis?
Phimosis = when the foreskin is too tight to be pulled backwards over the head of the penis. Paraphimosis = when the foreskin is too tight to be returned to its original position after being retracted
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Name 3 symptoms of bladder outlet obstruction which may be seen
Suprapubic pain, 'dribbling' after finishing voiding bladder, infections (due to stasis of blocked urine), weak stream of urine
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What is hydronephrosis? And how might you visualise it?
Swelling of the kidney with urine - due to a blockage preventing drainage of the urine. Would be best to use an ultrasound to discover this.
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What are the three zones of the prostate and what do they surround? (distal urethra, proximal urethra, and ejaculatory ducts i.e. seminal vesicle)
Peripheral zone = biggest part of normal prostate surrounding distal urethra. Transition zone = surrounds proximal urethra. Central zone = surrounds ejaculatory ducts
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Which zone most commonly is associated with benign prostatic hyperplasia (BPH)?
The transition zone - this zone keeps growing throughout life.
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Enlargement of which zone is associated with prostatic carcinoma?
Mostly in the peripheral zone.
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Name symptoms of BPH
Nocturia, frequency, urgency, post-micturition dribbling, poor stream, hesitancy, incontinence, bladder stones, UTI symptoms, haematuria (due to vessel rupture)
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What tests could you do to rule out malignancy?
mid-stream urine sample, U&Es, ultrasound (would also perhaps show nephrohydrosis) - perhaps transrectal with biopsy, PSA
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What is PSA and what concentration should be this below?
Prostate Specific Antigen. <4 ng/ml = normal, however depending on size and age 'normal' may be different for different people
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Why might you be cautious offering it to asymptomatic men who want the test?
PSA is not very accurate - only 1 in 3 with a high PSA have cancer. If the test is falsely positive then may have more needless tests which cause harm. Also most men with prostate cancer will die of something else anyway - so is treatment worth it?
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Uroflowmetry: >___ml needs to be passed for the bladder to be 'voided' and a flow rate of <__ml/sec suggests obstruction of weak bladder contractility
>150 ml needs to be passed. <12 ml = weak bladder contractility
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Prostate cancer it the most common malignancy in males. What kind of tumour is most common? Which zone does it develop in?
Adenocarcinomas in the peripheral zone (large part surrounding the distal prostatic urethra)
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How would you take a biopsy as the adenocarcinomas develop in the peripheral zone of the prostate?
You would take a biopsy transrectally (ultrasound guidance)
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How might the prostate feel in a pr/DRE?
It may feel hard and irregular, craggy (rough and uneven, 'rocky')
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PSA levels of > __ ng/mL = highly suggestive of tumour. Is the PSA a reliable tool for diagnosing prostate cancer?
>10 ng/mL = highly suggestive of tumour. However it is an unreliable method - PSA can be high in many men without cancer, it is also at a normal level in ~30% of those with prostate cancer
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What kind of scan would use to stage prostate cancer?
MRI (perhaps Bone XR w/ contrast)
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Name a method of grading prostatic cancer.
Gleason Grading. (or D'Amico grading using the Gleason score + stage + PSA level to give a more accurate reading)
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What is the Gleason score out of? a) 10 b) 20. What would a score of 9 suggest?
The Gleason score grades two areas of prostate tissue out of 5 meaning an overall score out of 10. Score of <6 = low risk and 8-10 = high risk
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What is the name of the stratification which combines Gleason score with clinical staging and PSA level?
D'amico risk stratification
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Other cards in this set

Card 2

Front

What is transitional epithelium?

Back

Transitional epithelium is a type of stratified epithelium. This tissue consists of multiple layers of epithelial cells which can contract and expand in order to adapt to the degree of distension needed.

Card 3

Front

Transitional epithelium lines the bladder - and where else?

Back

Preview of the front of card 3

Card 4

Front

Transitional Cell Carcinoma (TCC) mostly occurs in the bladder. How might it present?

Back

Preview of the front of card 4

Card 5

Front

Name 3 risk factors for a bladder TCC

Back

Preview of the front of card 5
View more cards

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