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Related Concept Videos

Urinary Tract Infection I: Introduction01:26

Urinary Tract Infection I: Introduction

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Urinary tract infections (UTIs) impact various parts of the urinary system, including the kidneys, ureters, bladder, and urethra. These infections are generally bacterial, with Escherichia coli being the most common causative agent, often originating from the gastrointestinal tract. However, other bacteria, such as Staphylococcus saprophyticus, Klebsiella pneumoniae, and Proteus mirabilis, are also known to cause UTIs. The type, location, and underlying complexity of the UTI guide both...
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Urinary Tract Infection II: Pathophysiology01:25

Urinary Tract Infection II: Pathophysiology

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The pathophysiology of urinary tract infections (UTIs) encompasses several progressive stages, beginning with bacterial colonization and culminating in potential systemic complications if untreated. UTIs are primarily initiated by bacteria, such as Escherichia coli, which often originate from the gastrointestinal tract and migrate to the urinary system through the periurethral area. This migration can occur via several routes, including improper hygiene practices, sexual activity, or...
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Urinary Tract Infection IV: Nursing Management01:17

Urinary Tract Infection IV: Nursing Management

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In managing urinary tract infections (UTIs) in nursing, a comprehensive assessment is essential. Begin by gathering subjective data, such as the patient’s complaints of dysuria (painful urination), urinary frequency, urgency, suprapubic pain, and any lower abdominal discomfort. This information can be complemented by questions regarding previous UTIs, sexual activity, and personal hygiene practices, which can provide insight into risk factors. Objective assessment should focus on signs...
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Nursing Assessment of the Genitourinary System I: Health History01:21

Nursing Assessment of the Genitourinary System I: Health History

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The genitourinary system is critical to maintaining fluid balance, waste elimination, and reproductive function. Nurses play a vital role in assessing this system, beginning with a thorough health history. This process involves gathering patient information, identifying risk factors, and recognizing symptoms of genitourinary disorders. Early detection is vital for timely interventions and management.1. Gathering Patient InformationA complete health history includes the patient’s personal,...
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Urinary Tract Infection III: Diagnostic Studies and Interprofessional Care01:30

Urinary Tract Infection III: Diagnostic Studies and Interprofessional Care

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A healthcare provider can diagnose a urinary tract infection (UTI) through several methods:Medical History and Symptoms: The provider will take a detailed medical history and ask about symptoms such as frequent urination, burning sensation during urination, and lower abdominal pain.Urinalysis: A clean-catch urine sample is collected in a sterile container and tested for the presence of bacteria, white blood cells (leukocytes), nitrites, blood, and protein. The presence of leukocytes and...
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Disorders of the Urinary System01:20

Disorders of the Urinary System

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The urinary system is responsible for eliminating waste and excess fluids from the body. However, disorders of the urinary system can arise due to various reasons like infections, stress, age, congenital abnormalities, and lifestyle.
Urinary tract infections (UTIs) are one of the most common urinary system disorders. They are caused by bacteria that enter the urethra and can spread to the bladder resulting in cystitis. Pyelonephritis is the result of a UTI that has ascended to the level of the...
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Iatrogenic changes in the urinary tract.

Antonio Lopez-Beltran1,2, Gladell P Paner3, Rodolfo Montironi4

  • 1Department of Pathology and Surgery, Faculty of Medicine, Cordoba, Spain.

Histopathology
|December 14, 2016
PubMed
Summary

Therapeutic procedures for urinary tract cancers can cause urothelial changes mimicking cancer. Pathologists must differentiate these therapy-related atypia from true neoplasia using immunohistochemistry to ensure accurate diagnosis and treatment efficacy.

Keywords:
atypiabladder flat lesionschemotherapyimmunotherapyradiation therapyurothelium

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Area of Science:

  • Uropathology
  • Oncology
  • Medical Diagnostics

Background:

  • Urinary tract cancer treatments, including intravesical immunotherapy (e.g., bacillus Calmette-Guérin) and chemotherapy (e.g., mitomycin C, platin-based), induce urothelial morphological changes.
  • These treatment-induced changes can be mistaken for urothelial carcinoma in situ (CIS), dysplasia, or invasive neoplasia, complicating pathological assessment.
  • Systemic drugs (e.g., cyclophosphamide, ketamine) used for other conditions can also cause similar atypical urothelial changes.

Purpose of the Study:

  • To highlight the diagnostic challenges posed by therapy-related urothelial atypia.
  • To emphasize the importance of differentiating treatment-induced changes from true neoplasia.
  • To inform pathologists about potential mimics of urothelial carcinoma in the post-therapy setting.

Main Methods:

  • Review of therapeutic procedures for urinary tract malignancies and their known effects on urothelium.
  • Identification of specific drugs and therapies that cause atypical urothelial changes.
  • Discussion of immunohistochemical markers (p53, cytokeratin 20, CD44) for distinguishing reactive changes from neoplasia.

Main Results:

  • Therapeutic modalities frequently produce morphological changes in the urothelium that mimic urothelial carcinoma.
  • Various systemic drugs, not directly related to cancer treatment, can also induce similar atypical changes.
  • Immunohistochemistry offers a valuable approach to differentiate reactive urothelium from carcinoma in situ in post-therapy cases.

Conclusions:

  • Pathologists must be aware of therapy-related atypia to avoid misdiagnosing urothelial neoplasia.
  • Accurate differentiation is crucial for evaluating treatment efficacy and guiding patient management.
  • Understanding these diagnostic mimics improves the reliability of pathological assessments in oncology.