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The Lower Urinary System and Male Genital System

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Title: The Lower Urinary System and Male Genital System


1
The Lower Urinary System and Male Genital System
2
The Lower Urinary Tract
  • Congenital anomalies
  • Ureteropelvic junction obstruction most
    common cause of hydronephrosis in infants and
    children, boysgtgirls, 20 bilateral

3
Ureteral Obstructive Lesions
  • Intrinsic
  • Calculi
  • Strictures
  • Tumors
  • Blood clots
  • Neurogenic
  • Extrinsic
  • Pregnancy
  • Periureteral inflammation
  • Endometriosis
  • Tumors

4
Sclerosing Retroperitoneal Fibrosis
  • Fibrous proliferative inflammatory process
    encasing the retroperitonal structures and
    causing hydronephrosis
  • Similar to Riedel thyroiditis
  • 70 no identifiable cause ( Ormond disease)
  • Drugs ( ergot derivatives, Beta blockers)
  • Adjacent inflammatory conditions
  • (Crohn disease)
  • Malignant disease ( lymphoma, UT carcinoma)

5
Urinary Bladder
  • Congenital anomalies
  • Diverticula
  • Exstrophy
  • VUR
  • Patent urachus

6
Cystitis
  • Bacterial
  • E. Coli, Proteus, Klebsiella, Enterobacter
  • TB
  • Candida, Cryptococcal
  • Chlamydia, Mycoplasma
  • Schistomiasis
  • Adenovirus
  • Predisposing factors
  • Female, calculi, urinary obstruction, DM,
    instrumentation, immune deficiency
  • Triad
  • Frequency, Lower abdominal pain, Dysuria
  • Special forms
  • Interstitial chronic pelvic pain
  • Malacoplakia soft yellow, raised mucosal
    plaques
  • Polypoid irritation to the bladder mucosa
  • Hemorrhagic- adenovirus, cyclophosphamide
  • Follicular- aggregates of lymphocytes

7
Metaplastic lesions
  • Cystitis cystica et glandularis- nests of
    urothelium grow downward into lamina propria
  • Squamous metaplasia
  • Nephrogenic adenoma shed renal tubular cells
    that implant in the urothelium in response to
    injury

8
Neoplasms
  • Urothelial ( transitional) tumors
  • 90 of all bladder tumors
  • Exophytic papillomas
  • Inverted papillomas
  • PUNLMPs- papillary urothelial neoplasms of low
    malignant potential
  • Low grade and high grade papillary urothelial
    cancers
  • CIS

9
Epidemiology
  • Malesgt Females
  • Cigarette smoking
  • Industrial exposures to arylamines
  • Schistosoma infections
  • Long-term use of analgesics
  • Long-term exposure to cyclophosphamide
  • Prior exposure to irradiation
  • Chromosome 9 deletions
  • Clinical painless hematuria

10
Urethra
  • Urethritis
  • GC
  • Chlamydia, Mycoplasma,
  • Enteric organisms
  • Reiters syndrome
  • Urethral carbuncle
  • Peyronie disease subcutaneous fibrosis
  • Carcinoma

11
Male genital tract
  • Penis
  • hypospadias
  • Epispadias
  • Phimosis
  • Balanoposthitis
  • Condyloma acuminatum
  • CIS
  • Bowen disease single erythematous plaque
  • Bowenoid Papulosis multiple warty lesions, HPV
    16
  • Invasive Squamous cell carcinoma

12
Testes and Epididymis
  • Cryptorchidism- increased incidence of germ cell
    tumors
  • Atrophy and decreased fertility
  • Nonspecific epididymitis and orchitis
  • Granulomatous ( auto-immune) orchitis
  • GC
  • Mumps
  • TB
  • Syphilis
  • Torsion bell clapper deformity
  • Tunica Vaginalis
  • Hydrocele, Hematocele, Chylocele, Spermatocele,
    Varicocele

13
Testicular Tumors
  • Germ Cell tumors
  • Seminomas very radiosensitive, most frequent,
    analogous to dysgerminoma in females
  • Spermatocytic Seminoma
  • Embryonal carcinoma second most common,
    painful, worse prognosis
  • Yolk Sac tumor
  • Choriocarcinoma
  • Teratoma almost always malignant
  • Mixed tumors
  • Clinical features
  • Painless enlargement of the testis
  • Spread via para-aortic nodes to medistinal and
    supraclavicular
  • NSGCTs more aggressive , poorer prognosis
  • HCG, AFP, LDH
  • Sex Cord-Gonadal Stroma
  • Leydig Cell precocious puberty
  • Sertoli Cell no endocrine
  • Gonadoblastoma
  • Testicular Lymphoma

14
Prostate
  • 4 biologically and anatomically distinct zones
  • Peripheral most carcinomas
  • Central
  • Transitional most hyperplasia
  • Anterior fibromuscular stroma

15
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16
Prostatitis
Acute bacterial Same organisms as UTIs Fever, chillls, dysuria, tender,boggy prostate
Chronic bacterial Recurrent UTIs Low back pain, abd discomfort, dysuria
Chronic abacterial Most common form Negative culture Leukocytes in fluid
Granulomatous BCG treatment for bladder cancer Reaction to secretions from ruptured ducts
17
Benign Prostatic Hyperplasia
  • Nodular hyperplasia
  • Very common in mengt50 years of age
  • Partial or complete obstruction of urethra
  • Overall reduction in the rate of cell death
  • DHT from stromal cells
  • induces growth factors
  • Bladder hypertrophy and distension
  • Urine retention
  • Frequency, nocturia, difficultystarting and
    stopping stream, overflow dribbling, dysuria
  • Increased risk of infection
  • Sudden acute urine retention emergency
    catherization

18
Prostate Tumors
  • Adenocarcinoma
  • Most common cancer in men
  • Androgens play an important role
  • FH important
  • BRCA2
  • Inflammation may set the stage
  • TMPRSS2 promoter, ETS gene
  • Hypermethylation of GSTRP1
  • EZH-2
  • AMACR
  • PCA3
  • PSA organ specific, velocity of change

19
Prostate Tumors
  • PIN high grade prostatic intraepithelial
    neoplasia
  • Gleason score 2 numeric grades added together
  • Gritty and firm
  • Outer layer of basal cell layer is absent in
    carcinoma
  • Grade and stage are best prognostic factors
  • Boney metastases in vertebrae universally fatal
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