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Lower Urinary Tract & Male Genital (Ureter: Obstructive lesions …
Lower Urinary Tract & Male Genital
Ureter: Congenital anomaly
2-3% autopsies
most no clinical significances
Cause obstruction
Congenital anomalies
1)Double ureters
asssoc/ double renal peves, partially bifid pelvis
2)Congenital/acquired ureteropelvic junction obstructions
MCC: hydronephrosis in infants & children Males
Adults: Women; Unilateral
Abnormal smooth muscle bundles @ UPJ excess collagen, extrinsic compression of UPJ by renal vessels
3)Diverticula
Saccular outpouching of ureteral wall
Pockets of stasis & 2ndary infections
Ureters:Inflammation
Ureteritis: NOT assoc w/infection
1) Ureteritis follicularis
lymphocytes->germinal centers in subepithelial region= inc mucosa and fine ganular mucosa surface
2) Ureteritis Cystica
mucosa sprinkled w/ fine cyst 1-5 mm; lined=flattened epithelium
Ureters: Tumor & tumor-like lesions
1)Fibroepithelial Polyp
small mass projecting->lumen (children)
Seen in bladder, Renal P., urethra
Polyp comp. of loose, vascularized connective tissue overlaid by urothelium
Primary tumors=rare
Benign: Mesenchymal=origin
2)Primary malignant tumors
6-7th decade of life
Cause obstruction in ureteral lumen
resemble those arising in renal pelvis, calyces, bladder MAJORITY=urothelial carcinomas)
occurs w/ similar neoplasms in bladder or renal pelis
Ureter: Obstructive lesions
Rise to: hydroureter, hydronephrosis, pyelonephritis
Bilateral obstruction arises from
distal
causes (nodular hyperplasia of the prostate
Unilateral obstruction results from
proximal
causes
In Children
Congenital UPJ obstruction Most common
In Adults
Chronic: intrinsic, extrinsic tumors; idiopathic conditions: sclerosing retroperitoneal fibrosis
Acute: Obstructing calculi
1)Sclerosing Retroperitoneal fibrosis
Fibrotic proliferative inflammatory process encase retroperitoneal structures
Causing=hydronephrosis
Middle-late age males
IgG4 disease =elev serum IgG4, fibroinflammatory lesions rich in IgG4-secreting plasma cells
Drug exposures, adjacent inflammatory conditions, malignant disease
Fibrous tissue comp. lymphocytes, w/ germinal centers, plasma cells, eosinophils
Tx: Corticosteroids, ureteral stents, surgical extrication of ureters