Haematuria and urological tumours

34 Haematuria and urological tumours





Questions



image What are the causes of haematuria and how should it be investigated?

image What are the causes of bladder tumours?

image What is intravesical therapy?

The urological tumours involve the bladder, ureters and kidney. The most common presenting symptom of these tumours is painless haematuria (blood in the urine); one in five of those with macroscopic haematuria have a urinary tract malignancy.




Haematuria


Haematuria is either macroscopic (frank) or microscopic (detectable on dipstick). All patients with macroscopic haematuria and those over 40 years with microscopic haematuria should be referred to rapid access clinics. The causes of haematuria are shown in (Fig. 3.34.1):


image

Fig. 3.34.1 The causes of haematuria (common causes in bold).


The following investigations are performed:


image mid-stream urine: microscopy and culture for urinary tract infection causing haematuria

image ultrasound and intravenous urogram: to identify anatomy and filling defects of the upper tract

image flexible cystoscopy with biopsy: cancer can be detected using a cystoscope to view inside the bladder; multiple biopsies are taken.


Bladder tumours


Transitional cell epithelium lines the bladder and ureters; a carcinoma arising from this lining is a urothelial tumour. The bladder is the most commonly affected site (95%).



Aetiology


Bladder tumours are associated with:


image male:female ratio of 2:1; most common in men aged 60–80 years

image cigarette smoking: most common proven association

image aromatic amines: increased risk with rubber industries (tyre and rubber manufacturers); dyes, paints and plastics; diesel fumes; tumours may arise up to 20 years later
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Jul 3, 2016 | Posted by in MUSCULOSKELETAL MEDICINE | Comments Off on Haematuria and urological tumours

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