Malformasi

1. Hipospadia: orificium urethra pada bag.ventral penis
2. Epispadia: orificium urethra pada bag.dorsal penis

Radang

1. Balanitis & Balanoposthitis
   
   • Radang lokal pada glans penis dan preputium
   • Etiologi: candida albicans, bakteri anaerob, gardnerella dan bakteri pyogenic
   • Karena poor hygiene pada pria yang tidak sunat menyebabkan akumulasi sel epitel lepas, keringat dan debris menjadi iritan local
2. Phimosis
   
   • Kondisi dimana preputium tidak bisa ditarik ke belakang gland penis.
   • Dapat kongenital maupun akibat balanosposthitis yang menyebabkan jaringan parut

Neoplasma

• Lebih dari 95% neoplasma penis berasal dari epitel squamous → SCC
  
  • Faktor risiko: laki-laki tidak bersunat >40 thn, poor hygiene, merokok, infeksi HPV type 16, 18

1. Bowen disease
   
   • SCC in situ, plak pada batang penis, displasia, 10%nya menjadi invasive SCC
     
2. Invasive SCC
   
   • Papular, berkrusta, ulserasi, keratinizing SCC
     

1. Hydrocele
   
   • Pembengkakan skrotum karena akumulasi cairan serous dalam tunika vaginalis
   • Etiologi: idiopatik, respons terhadap radang atau tumor
   • Pemeriksaan transiluminasi
     
2. Hematocele
   
   • Akumulasi darah
3. Chylocele
   
   • Akumulasi cairan limfatik

1. Kriptorkidismus
   
   
   • Merupakan kegagalan testis turun ke skrotum
   • Dapat unilateral maupun bilateral
   • Etiologi: tidak diketahui, pada kondisi bilateral kemungkinan disertai kelainan kromosom
   • Normalnya testis turun ke pelvis pada bulan ke 3 gestasi, dan mencapai skrotum lewat kanal inguinalis pada akhir bulan ke 2 kehidupan intrauterine
   • Dapat menyebabkan atrofi testis, infertilitas dan keganasan testis
2. Atrofi testis
   
   • Selain disebabkan oleh kriptorkidismus juga dapat disebabkan iskemia kronis, trauma, radiasi, kemoterapi, dan peningkatan level estrogen

Orchitis bisa disebabkan oleh sexually transmitted disease maupun non specific orchitis, mumps, Tb

• Non specific orchitis bisa disebabkan oleh UTI yang menyebar melalui vas deferens, saluran limfatik, maupun spermatic cord
  
  • Testis biasanya bengkak dan terdapat nyeri tekan
  • Mikroskopis banyak didapatkan neutrophil
• Mumps bisa menyebabkan testis bengkak, terdapat limfoplasmasitik infiltrate
• Tuberculosis bisa menyebabkan gambaran granulomatous pada testis

Torsio testis

• Merupakan kelainan dimana spermatic cord terpluntir sehinga menyebabkan obstruksi venous drainage dan infark
• Type:
  
  1. Neonatal torsion: in utero
  2. Adult torsion: sering pada dewasa muda
• Gx: nyeri tiba-tiba pada testis
• Golden period: 6 jam

Seminoma

• Makros: tumor berbentuk bulat lobulated, berwarna putih-abu abu
• Mikros:
  
  • Lobulated, dipisahkan oleh septa jaringan ikat tipis
  • Sel-sel uniform batas antar sel jelas, sitoplasma jernih
  • Inti bulat, nampak jelas anak inti
  • Banyak infiltrasi limfosit

Teratoma

• Tumor yang berasal dari 3 germ layer (bisa terjadi pada bayi-dewasa)
• Sebagian padat sebagian kistik
• Tumor terdiri dari struktur heterogen yang terdiri atas jaringan otal, otot, kartilago, epitel squamous, adnexa kulit, kelenjar tiroid, usus

Prostatitis terbagi menjadi 3 kategori:

1. Acute bacterial prostatitis (2-5%): berhubungan dgn UTI akut, gejala demam, menggigil, dysuria, nyeri perineum, bladder obstruction
2. Chronic bacterial prostatitis (2-5%): disebabkan oleh uropathogen umum, berhubungan dengan rekurensi UTI asimptomatis, gejala nyeri punggung bawah, dysuria, rasa tidak enak pada perineal dan suprapubic
3. Chronic pelvic pain syndrome (90-95%): didapatkan leukosit pada secret prostat, nyeri saat dan setelah ejakulasi

BPH merupakan pembesaran prostat tersering akibat proliferasi sel stromal dan glandular, pada pria >40 thn

• Klinis: urinary tract obstruction (hesitancy, interruption, urgency, frequency, nocturia)
• Makros: prostat membesar (60-100 gram), nodul-nodul solid terdapat area kistik, uretra menyempit
  
• Mikros:
  
  • Proliferasi kelenjar dan stroma fibromuscular
  • Kelenjar hiperplastik dilapisi 2 lapis sel yaitu sel columnar tinggi dan sel basal pipih
  • Nampak corpora amylacea
    

Adenoca prostat merupakan kanker terbanyak pada pria (usia >50 thn)

• Patogenesis: Mutasi TPRSS2-ETS → cell growth and survival
• Serum PSA dapat digunakan untuk screening
• Morfologi: Kelenjar dilapisi selapis columnar epitelium, tidak didapatkan sel basal, nuclei membesar
• Klinis: karena letak perifer, kecil dan asimptomatik kadang incidental found
• Muncul pada zona perifer (teraba pada DRE)
• Grading menggunakan gleason score
  

Overview

1. Renal component: glomeruli, tubules, interstitium, vascular
2. Renal function:
   
   • Excretion of the waste products of metabolism
   • Regulation of body water and salt
   • Maintenance of acid balance
   • Secretion of hormones and prostaglandin

Glomerular Intro:

• Glomerular: jar.kapiler yang tertanam pada 2 lapis epitel

• Podocytes: membungkus kapiler

  
  
  

  

• Glomerular consist of an anastomosing network of capillaries invested by two layers of epithelium
  
  • Visceral epithelium composed of podocytes
  • Parietal epithelium encircles Bowman space (urinary space)
• Glomerular basement membran consist of collagen (mostly type IV, laminin, polyanionic proteoglycans, fibronectin, and several other glycoproteins.
• Mesangial cells lie in mesangial matrix between the capillaries that support the glomerular tuft.

Patogenesis of "glomerulonephritis caused by circulating immune complexes":

Ag (endogen, exogen, unknown) → karena ada ag → ada complex (Ag-Ab complexes) → mengaktivasi sistem komplemen → rekrut leukosit → injury

• Ikatan ag ab di pemb,darah terdeposisi di ginjal
  
  

Patogenesis of "glomerulonephritis caused by immune complexes formed in situ":

• Deposition of antibodies specific for fixed (intrinsic) or planted (from outside) antigens in the glomerulus
  
  • Antigens expressed by podocytes have been implicated in membranous nephropathy
  • Planted antigens include nucleosomal complexes, mainly derived from breakdown of apoptotic cells, in patients with SLE; bacterial products; and large agregated protein which tend deposit in mesangium.
    
    

Patogenesis of "glomerular diseases caused by complement activation":

• Less frequent
• Unregulated activation of the alternative complement pathway, which may be trigerred by acquired autoantibodies against complement components or inherited abnormalities of complements regulatory proteins.
  
  

Bedanya kalau sama yang circulating itu ada banyak ikatan Ag-AB, kalau ini gangguan pada protein regulator

Patogenesis of "podocyte injury":

• Can be induced by antibodies to podocyte antigens, by toxin, certain cytokines (tidak ada mekanisme autoimun yg memengaruhi)
• Podocytes injury produces morphologic changes:
  
  • Effacement of foot processes, vacuolization, retraction, dettachment cells from the GBM
    
    

Patogenesis of "nephron loss":

• Nephron: 1 unit glomerular + renal tubule
• Destroy sufficient nephron can reduce GFR to 30-50%
  

Primary Glomerulopathies/ Primary Glomerular Disease (explanation) → 9 disease:

1. Minimal Change Disease

   
   

   Defintiion: relatively benign disorder, is the most frequent cause of the nephrotic syndrome in children and is characterized by glomeruli that have a normal appearance by light microscopy

   
   
   • Patogenesis Some circulating molecules (unknown) injure podocytes and cause proteinuria with effacement of foot processes
   • Klinis: nephrotic syndrome
   • Morphology:
     
     • Light microscope: normal
     • Fluorescent microscope: (-)
     • Electron microscope: diffuse effacement of the foot processes
       
       

2. Focal Segmental Glomerulosclerosis

   
   

   Definition: FSGS is characterized by sclerosis of some (but not all) glomeruli that involves only a part of each affected glomerulus. May be primary (idiopathic) or secondary to one of the following conditions: HIV, heroin abuse, inherited

   
   
   • Patogenesis: podocytes injury
   • Klinis: nephrotic synd., hematuria & htn
   • Morphology:
     
     • Light microscope: PAS staining: increased mesangial matrix, obliterated capillary lumina, deposition of hyaline
       
       
       • ⭐ Bedanya sama MCD pada gambaran light microscopy
     • Fluorescent microscope: Non spesific trapping IgM in the area of hyalinosis
     • Electron microscope: effacement of the foot processes
       

3. Membranous Nephropathy

   
   

   Definition: membranous nephropathy is characterized by subepithelial Ig-containing deposits along the GBM. Occurs secondary to other conditions: (infections (chronic hepatitis B, syphilis, schistosomiasis), malignant neoplasm (lung ca, colon ca, melanoma), autoimmune disease (SLE), exposure to inorganic salts (gold, mercury), drugs (penicilamine, captopril, NSAID)

   
   
   • Patogenesis: antibodies reacting insitu to endogenous or planted glomerular antigen
   • Klinis: nephrotic synd., usually failed to corticosteroid therapy
   • Morphology:
     
     • Light microscope: diffuse thickening of capillary wall
       
     • Fluorescent microscope: granular deposit
     • Electron microscope: spikelike protrusion of deposit in subepithelial
       
       

Dari 3 penyakit diatas:

• Gejala ketiga kelainan ini hampir sama, tapi pada membranous nephropathy biasanya tidak respon dengan terapi corticosteroid, dan didapatkan kelainan padapmx light micros yaitu pada glomerulus didapatkan diffuse thickening dinding kapiler
  
  • Didapatkan kaitannya dengan mekanisme imun, karena tanda dari membranous nephropathy didapatkan deposit di sepanjang subepithelial GBM mengandung Ig

4. Membranoproliferative Glomerulonephritis

   
   

   Definition: MPGN is manifested histologically by alteration in the GBM and mesangium and by proliferation of glomerular cells.

   
   
   • Patogenesis: caused by deposition of circulating immune complexes or by in situ immune complex formation with a planted antigen
   • Klinis: nephrotic syndrome, begin with acute nephritis or mild proteinuria (nephrotic diawali nephritis synd. akut)
   • Morfologi:
     
     • Light microscope: glomeruli are large with proliferation of mesangial and endothelial cells with leukocytes infiltration (pembesaran glomerulus, proliferasi sel mesangial dan sel endotel, dengan infiltrasi leukosit)
     • Fluorescent microscope: C3 is deposite in a irregular granular pattern (C3 granular)
     • Electron microscope: discrete subendothelial deposits (deposit subendothelial menyebar (nyeplok2))
       
       

5. C3 Glomerulopathy

   
   

   Definition: the term C3 glomerulopathy encompasses 2 conditions: dense deposit disease (formerly: MPGN type II) and C3 glomerulonephrities.

   
   
   • Patogenesis: complement dysregulation (acquired/hereditary)
   • Klinis: nephrotic /nephritic snyd.
   • Morphology:
     
     • Light microscope: = MPGN I
     • Fluorescent microscope: dense deposit of C3 along the mesangial, capilaries wall and tubular basement membran
     • Electron microscope: waxy deposit or ribbonlike deposit in mesangial, subendothelial, tubular basement membran
       
       
       

Dari 2 penyakit diatas:

• Kelainan yang sama dengan MPGN I, dulu dinamakan MPGN type II
  
  • Light micros: = MPGN I
  • Tapi deposit dari C3 tebal dan luas bukan hanya di subendothelial
  • PG dikarenakan disregulasi komplemen
    

6. Acute Post-Infectious (Post-Streptococcal) Glomerulonephrities

   
   

   Definition: acute postinfectious GN is caused by glomerular deposition of immune complexes resulting in proliferation and damage to glomerular cells and infiltration of leukocytes, especially neutrophils.

   
   
   • Pada pasien dengan post strepto infection, Ikatan imun menyebabkan aktivasi sistem komplemen dan merusak glomerulus
   • Patogenesis: immune complex disease which tissue injury is primarily caused by complement activation by the classical pathway
   • Klinis: nephritic synd., 1-4 week after recover from streptococcal infection from pharynx or skin
   • Morphology:
     
     • Light microscope: glomerular hypercellularity caused by infiltration of leukocytes and glomerular cells
       
     • Fluorescent microscope: granular deposits of IgG
     • Electron microscope: subepithelial hump deposits
       

7. IgA Nephropathy

   
   

   Definition:IgA nephropathy is one of the common cause hematuria and is the most common glomerular disease revealed by renal biopsy worldwide. The hallmark of the disease is the deposition of IgA in the mesangium.

   
   
   • Patogenesis: the abnormal of IgA1
   • Klinis: children and young adults, hematuria can develop to acute nephritic syndrome
   • Morphology:
     
     • Light microscope: maybe normal or mesangial proliferation (Non spesific morphology)
     • Fluorescent microscope: mesangial deposition of IgA
     • Electron microscope: eletron dense deposit in mesangium
       
       

Dari penyakit MCD & IgA, resume:

• Sama dengan MCD pada anak2, tapi beda gejala ini dengan hematuria,
• Penyebab tersering hematuria
• Light microscope: normal, ga spesifik
• Fluor : deposisi IgA
  
  
  

8. Rapidly Progressive Glomerulonephritis
   Definition: RPGN is characterized by the presence of crescents and in most cases appears to be immunologically mediated
   
   • Patogenesis: associated with a number of disease: anti-GBM antibody mediated (Godpasture disease), immune complex-mediated, pauci-immune type (ANCA)
   • Klinis: nephritic syndrome
   • Morphology:
     
     • Light microscope: crescent formation formed both by proliferation of epithelial cells and by migration of monocytes
       
     • Fluorescent microscope: linear staining of IgG and C3 along the GBM
     • Electron microscope: rupture of GBM