Urinary tract diseases I 2024.pptx

Urinary tract disorders - I Overview Urinary tract infection Bladder cancer Urinary incontinence Learning outcomes  To understand pathological features of urinary tract infection, bladder cancer and urinary incontinence  To describe the main clinical characteristics of these diseases Urinary t...

Urinary tract disorders - I Overview Urinary tract infection Bladder cancer Urinary incontinence Learning outcomes  To understand pathological features of urinary tract infection, bladder cancer and urinary incontinence  To describe the main clinical characteristics of these diseases Urinary tract disorders - I Overview Urinary tract infection Bladder cancer Urinary incontinence Clinical overview Urine formed from kidney passes down the urinary tract before exiting the body Bladder − Stores the urine − Void intermittently under voluntary control The most common diseases of the urinary tract: − Benign prostatic hyperplasia (BPH) in men − Urinary tract infection (UTI) in women − Urinary incontinence The symptoms that suggest urinary tract disease: Frequency of micturition Dysuria Haematuria Urinary retention Urinary tract disorders - I Overview Urinary tract infection Bladder cancer Urinary incontinence Urinary tract infection Urinary tract infection (UTI) is common − Incidence 50,000/million/year − Account for 1-2% patients in primary care More common in women Major form of UTI: − Cystitis Cystitis Inflammation of the bladder; common in UTI More common in women Acute or chronic Mainly caused by infection; pathogens: − Most common: E. Coli and Proteus − Others (Candida albicans, Cryptococcus, Schistosoma, Mycobacterium tuberculosis) Sterile cystitis − Radiation − Drugs Cystitis - Presentations The classic symptoms of cystitis: − Urgency − Frequency − Dysuria − Lower abdominal pain & tenderness  Complication: pyelonephritis Cystitis - Pathology Non-specific acute or chronic inflammation Acute cystitis: mucosa becomes hyperaemic, often producing an exudate Chronic cystitis: – results from recurrent or persistent infection of the bladder. – Chronic infection fibrous thickening & scarring; bladder wall less distensible Cystitis - Diagnosis & Treatment Diagnosis: Urine bacterial count; microscopy, WBCs, Treatment − 3-5 day course of antibiotics − High fluid intake, (cranberry juice) Recurrent infection: investigation Pathology: Non-specific acute or chronic inflammation Presentations:  Acute or chronic  The classic symptoms of cystitis: - Urgency - Frequency - Dysuria - Lower abdominal pain & tenderness  Complication: pyelonephritis Pathogens:  E. Coli and Proteus  Other organisms Diagnosis: Urine bacterial count Microscopy, WBCs Treatment: Antibiotics High fluid intake, (cranberry juice) Recurrent infection: investigation Urinary tract disorders - I Overview Urinary tract infection Bladder cancer Urinary incontinence Bladder tumours Metaplasia: urothelium (transitional cell lining) of the bladder can undergo metaplastic changes  Squamous metaplasia  Intestinal or glandular metaplasia  Nephrogenic metaplasia Benign tumours of the bladder- rare, 2-3% of epithelial tumours Transitional cell carcinomas: − common malignant tumours arising from transitional cell epithelium − account for 90%+ of bladder epithelial cell tumours Transitional cell carcinomas Uncommon under 50 yrs old; more commonly affect males (4 males: 1 female) Notoriously silent tumours: 50% incurable at diagnosis The most common presentation is painless haematuria Often accompanied by symptoms of UTI (dysuria, frequency and urgency) Symptoms of local invasion: ureteric obstruction Transitional cell carcinoma  Risk factors Smoking Exposure to acrylamine chemicals in industry (naphthylamine, benzidine) Drugs Analgesic abuse Immunosuppressive agents (cyclophosphamide) Radiation Transitional cell carcinoma  Pathology Two main types of transitional cell tumour: Papillary tumour (70%) Sessile (flat) tumour In situ or invasive Graded to I-III according to cytological atypia Urothelial carcinoma Normal urothelium Flat carcinoma Urothelial carcinoma – Four patterns Transitional carcinoma - Clinical features Painless haematuria Symptoms of UTI: Dysuria Frequency Urgency Symptoms of local invasion Transitional carcinoma - Diagnosis & treatment Diagnosis: Urine cytological examination: - malignant cells Cystoscopy for pathology Treatment: According to the stage and histological grade Tumour resection using diathermy Radiotherapy Cystectomy Transitional carcinoma - Prognosis Five year survival 80% if bladder wall not involved 5% if local invasion on presentation Risk factors:  Smoking  Acrylamine chemicals in industry  Drugs (analgesics; immunosuppressive agents (cyclophosphamide))  Radiation Pathology: Transitional cell carcinoma (in situ or invasive):  Papillary tumour (70%)  Sessile (flat) tumour Graded I-III according to cytological atypia Clinical features:  Painless haematuria  Symptoms of UTI: dysuria, frequency, urgency  Symptoms of local invasion Treatment: According to the stage and histological grade  Tumour resection using diathermy  Radiotherapy  Cystectomy Diagnosis: Urine cytological examination: - malignant cells Cystoscopy for pathology Urinary tract disorders - I Overview Urinary tract infection Bladder cancer Urinary incontinence Urinary incontinence Defined as involuntary loss of urine Common in the elderly, 25% of women and 15% of man over 65 Socially distressing Types of urinary incontinence -I Urge incontinence − Due to detrusor overactivity with leakage of urine (the bladder is perceived to be full) − As isolated event − Secondary to local factors (bladder infection, stones) or central factors (stroke, dementia, Parkinson’s disease) Stress incontinence − Occurs when intra-abdominal pressure is increased (cough, sneeze) − Weak pelvic floor or urethral sphincter − Common in women after childbirth Types of urinary incontinence -II Overflow incontinence − Leakage of urine from a full distended bladder Commonly in men with prostatic obstruction Following spinal cord injury In women with cystocoeles or after gynaecological surgery Functional incontinence − Passage of urine owing to inability to get to a toilet because of disability (stroke, trauma, unavailability of toilet facilities or dementia) Urinary incontinence - Treatment  Urge incontinence − Bladder training − Antimuscarinics − Treatment of underlying causes (UTI, bladder stones, tumours)  Stress incontinence − Pelvic floor exercises  Overflow − Removal of obstruction  Functional incontinence − Improve facilities, regular urinary voiding, absorbent padding Which of the following is not a classic symptom of cystitis? a) Urgency b) Frequency c) Painless haematuria d) Dysuria e) All of the above Which of the following drugs is used for the treatment of urge incontinence? a) α antagonists b) ß antagonists c) muscarinic antagonists d) histamine antagonists e) None of the above