Passing dark colored urine

Passing dark colored urine

1. Urinary bladder carcinoma

   • Signs & symptoms
     • Hematuria
       • Hematuria Physiology
         • 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
       • Definition
         • 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
         • Grading Scale
       • Risk factors
         • Age
         • A recent infection
         • Family history
         • Certain medications
         • Strenuous exercise
       • Differential Diagnosis
     • 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
     • Bone pain
   • Histopathology of Bladder Carcinoma
     • Low grade - The border of the urinary bladder epithelium is seen. There is no invasion to the basement membrane
     • Papillary Urothelial carcinoma - The papillae have fibro-vascular cores.
     • Cytology
       • 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
     • Shistosomiasis
       • 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
   • Lab investigations
     • Intravenous pyelogram
       • 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.
       • Indications
         • kidney stones
         • Enlarged prostate
         • 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.
     • Imaging
       • Radiology
         • X-ray KUB
         • IVU
         • Abdominal U/S
         • CT & MRI
         • Angiography
         • Ascending cystography
         • Ascending urethrography
       • Endoscopy
         • Cystourethroscopy
         • Ureteroscopy
       • Renal biopsy
   • Treatment and management
   • Prognosis
     • 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.

2. Physiology of micturition

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