Initial hematuria arises from Urethra ( secondary to inflammation)
Total hematuria arises from: Bladder or upper UT
Terminal hematuria arises from: Bladder neck or prostate urethra
Hematuria is defined as the presence of 5 or more red blood cells (RBCs) per high-power field in 3 of 3 consecutive centrifuged specimens obtained at least 1 week apart.
Localization of hematuria
A recent infection
Having to urinate more often than usual
Pain or burning during urination
Feeling as if you need to go right away, even when the bladder is not full
Having trouble urinating or having a weak urine stream
Lower back pain on one side
Loss of appetite and weight loss
Feeling tired or weak
Swelling in the feet
Histopathology of Bladder
Low grade - The border of the urinary bladder epithelium is seen. There is no invasion to the
Papillary Urothelial carcinoma - The papillae have fibro-vascular
Can be used to detect CIS cells (flat malignant urothelium cells--> they shed, so they can be detected
via cytology) Or high grade urothelial carcinoma cells
It often leads to squamous cell carcinoma
Composed of well differentiated malignant squamous cells, with nests of keratinization
In the gut, liver, and blood vessels, there is a presence of granulomas with cercaraei of shistosomas
Tumor staging and grading
After T2, a complete bladder resection must be done
Before T2 --> BCG and tumor resection
x-ray examination that utilizes insertion of contrast material intravenously via an injection to assess the kidneys, ureters and bladder.
When contrast material is inserted into a vein via injection in the subject’s arm, it goes through the blood stream and precipitates in the kidneys and urinary tract, where these areas will become bright white on the x-ray images.
Tumors in the kidney, ureters or urinary bladder
Scarring from urinary tract infection
Surgery on the urinary tract
Congenital anomalies of the urinary tract
Prostate specific antigen
Protein produced by normal, as well as cancerous, cells of the prostate gland. The PSA test measures the level of PSA in a man’s blood.
Elevated in men with prostate cancer
Used in conjunction with a digital rectal exam (DRE) to test asymptomatic men for prostate cancer.
CT & MRI
Treatment and management
Patients at stage 2 and below have better prognosis than stages above stage 2
Squamous cell carcinoma. SCC of the urinary bladder is a malignant neoplasm that is derived from bladder urothelium and has a pure squamous phenotype.