UB Carcinoma

Dd of hematuria

Physiological: Exercise Induced 2. Pathological: • Systemic with local trigger as minor trauma ✓ Bleeding Tendency Hemophilia, Vasculitis (purpura) ✓ Drugs Anticoagulants, Rifampicin, Cyclophosphamide • Local ✓ Malignancy (UB, Urothelium, RCC, Prostate malignancy, urethral cancer) ✓ Infection (TB, Bilharziasis) ✓ Stone ✓ Trauma ✓ Severe , Uncontrolled HTN

Importance of asking about clots

Risk of Clot Retention: Clots in the urine can lead to urinary retention, a condition where blood clots obstruct the flow of urine, causing symptomatic urinary retention

Diagnostic method for bladder cance

r 1- Urine examination: a. The urine may show haematuria, necroturia, pyuria, offensive odour b. Urine cytology may show malignant cells. c. Culture and sensitivity is essential. 2- Renal function tests: impaired in late cases 3- Plain X-ray: Only in Bilharzial carcinoma, there is erosion of Bilharzial bladder calcification opposite the tumour. 4-Ultrasonography (External abdominal & pelvic , transrectal , transvaginal or transurethral) . 5-I.V.U.: Shows irregular filling defect in the urinary bladder. 6. Ascending cystography: Done if the renal function is impaired, it shows irregular filling defect. 7- C.T. scan is very important to detect the depth of invasion of primary tumour , affection of L.Ns , accurate staging . 8-Cystoscopy and Biopsy: The most important investigation , visualizes the tumor as an irregular mass with ulcers. 9- Investigations to detect metastases: (see cancer breast). 10. General assessment of the patient before operation: HB%, E.C.G. ....etc. Page: 1107

Why asking about rt hypochondrial pain in sheet

and signs of increased ict Metastatic Spread: Bladder cancer can metastasize to various organs, including the liver. Right hypochondrial pain can be a sign of liver metastasis, which is a serious complication indicating advanced disease. Urinary Tract Involvement: Pain in the right hypochondrial region can also be related to urinary tract involvement, such as hydronephrosis or ureteral obstruction, which can occur due to tumor growth or metastasis. Metastatic Brain Tumors: Bladder cancer can metastasize to the brain, leading to increased ICP. Symptoms of increased ICP include headache, nausea, vomiting, and altered mental status. These symptoms can be critical and require immediate medical attention. Paraneoplastic Syndromes: In some cases, bladder cancer can cause paraneoplastic syndromes, which are conditions caused by the immune system's response to the cancer. These syndromes can sometimes affect the central nervous system and lead to symptoms that mimic increased ICP

Importance of pr in this cas

e Detection of Pelvic Masses: Assessment of Metastatic Spread: The initial spread of urothelial bladder cancer is often by direct extension into adjacent organs and/or the pelvic side wall, through the lymph nodes, or hematogenously. The most likely locations for distant metastases are bone, liver, and lung. A DRE can help identify any palpable masses or abnormalities that might suggest local or regional metastasis.

Difference between micro and macroscopic hematuria

Microscopic Hematuria: Definition: Microscopic hematuria is the presence of red blood cells (RBCs) in the urine that is not visible to the naked eye. It is detected only through urinalysis or microscopic examination. Diagnostic Criteria: ≥3 RBCs per high-power field (HPF) on microscopic examination of a properly collected urine sample. Causes: Benign Causes: Vigorous exercise, menstrual contamination, urinary tract infections (UTIs), or recent catheterization. Pathological Causes: Kidney stones, glomerular diseases (e.g., IgA nephropathy), bladder or kidney cancer, or benign prostatic hyperplasia (BPH). Clinical Significance: Microscopic hematuria is often asymptomatic and may be detected incidentally during routine checkups. It requires further evaluation to rule out serious underlying conditions, especially in high-risk patients (e.g., smokers, older adults). Evaluation: Urinalysis: To confirm hematuria and check for other abnormalities (e.g., proteinuria, pyuria). Urine Cytology: To detect abnormal cells (e.g., in bladder cancer). Imaging: CT Urogram: Gold standard for evaluating the upper urinary tract (kidneys and ureters). Ultrasound: Alternative for patients who cannot undergo CT (e.g., pregnant women, renal impairment). Cystoscopy: To evaluate the bladder and urethra, especially in patients at risk for bladder cancer. Macroscopic Hematuria (Gross Hematuria): Definition: Macroscopic hematuria is the presence of visible blood in the urine, giving it a red, pink, or cola-colored appearance. Diagnostic Criteria: Blood in the urine is visible without magnification. Causes: Common Causes: Kidney stones, UTIs, trauma, or bladder/prostate cancer. Less Common Causes: Glomerular diseases (e.g., glomerulonephritis), bleeding disorders, or strenuous exe

Complications of hematuria

Hypertension Malignancy Infection Urinary Tract Obstruction Anemia Renal Damage or Failure

Investigations for this case 1

- Urine examination: a. The urine may show haematuria, necroturia, pyuria, offensive odour b. Urine cytology may show malignant cells. c. Culture and sensitivity is essential. 2- Renal function tests: impaired in late cases 3- Plain X-ray: Only in Bilharzial carcinoma, there is erosion of Bilharzial bladder calcification opposite the tumour. 4-Ultrasonography (External abdominal & pelvic , transrectal , transvaginal or transurethral) . 5-I.V.U.: Shows irregular filling defect in the urinary bladder. 6. Ascending cystography: Done if the renal function is impaired, it shows irregular filling defect. 7- C.T. scan is very important to detect the depth of invasion of primary tumour , affection of L.Ns , accurate staging . 8-Cystoscopy and Biopsy: The most important investigation , visualizes the tumor as an irregular mass with ulcers. 9- Investigations to detect metastases: (see cancer breast). 10. General assessment of the patient before operation: HB%, E.C.G. ....etc

How to assess systemic causes of hematuria

History and Physical Examination Medical History: Ask about recent infections (e.g., streptococcal infection, which may suggest post-infectious glomerulonephritis). Inquire about systemic symptoms such as fever, weight loss, fatigue, or joint pain (may suggest autoimmune diseases like lupus or vasculitis). Assess for a history of trauma, exercise, or recent urological procedures. Evaluate for a family history of kidney disease, bleeding disorders, or sickle cell disease. Ask about medications (e.g., anticoagulants, cyclophosphamide, NSAIDs) that may cause hematuria. Physical Examination: Check for signs of systemic disease: Hypertension or edema (suggestive of glomerular disease). Rash or joint swelling (may indicate lupus or vasculitis). Pallor or bruising (suggestive of a bleeding disorder). Abdominal masses or tenderness (may indicate malignancy or infection). 2. Laboratory Tests Urinalysis: Confirm hematuria and assess for dysmorphic red blood cells (RBCs), RBC casts (suggestive of glomerular origin), or white blood cells (WBCs) and bacteria (suggestive of infection). Blood Tests: Renal Function Tests: Serum creatinine and blood urea nitrogen (BUN) to assess kidney function. Complete Blood Count (CBC): Look for anemia, thrombocytopenia, or signs of infection. Coagulation Profile: PT/INR, aPTT to evaluate for bleeding disorders. Inflammatory Markers: ESR, CRP (elevated in autoimmune or inflammatory conditions). Autoimmune Workup: ANA, anti-dsDNA, ANCA (to rule out lupus or vasculitis). Complement Levels: Low C3 and C4 may suggest immune complex-mediated diseases like post-infectious glomerulonephritis or lupus nephritis. Serum Protein Electrophoresis (SPEP): To screen for multiple myeloma. Infection Screening: ASO titers (for post-streptococcal glomer

What are luts

Storage Symptoms (related to bladder filling): Increased daytime frequency: Needing to urinate more often during the day. Nocturia: Waking up at night to urinate. Urgency: A sudden, compelling need to urinate that is difficult to defer. Urge incontinence: Leakage of urine associated with urgency. Voiding Symptoms (related to bladder emptying): Slow stream: Reduced urine flow. Hesitancy: Difficulty initiating urination. Intermittency: Stopping and starting during urination. Straining: Needing to strain or push to urinate. Terminal dribbling: Prolonged final part of urination. Post-Micturition Symptoms (after urination): Incomplete emptying: Feeling that the bladder is not fully emptied. Post-micturition dribble: Leakage of urine after finishing urination.

How to differentiate between nephrogenic and bladder hematuria

. Clinical History Nephrogenic Hematuria: Associated with systemic symptoms like fever, fatigue, or weight loss. History of recent infections (e.g., sore throat or skin infection suggesting post-streptococcal glomerulonephritis). Family history of kidney disease (e.g., polycystic kidney disease, Alport syndrome). Hypertension or edema (suggestive of glomerular disease). Use of medications that can cause glomerular injury (e.g., NSAIDs, antibiotics). Bladder Hematuria: Associated with lower urinary tract symptoms (LUTS) such as dysuria, urgency, frequency, or suprapubic pain. History of urinary tract infections (UTIs), bladder stones, or trauma. Risk factors for bladder cancer (e.g., smoking, occupational exposure to chemicals, age > 50 years). Recent urological procedures or catheterization. 2. Physical Examination Nephrogenic Hematuria: Hypertension or signs of fluid overload (e.g., edema). Rash or joint swelling (suggestive of autoimmune diseases like lupus or vasculitis). Flank pain or tenderness (may indicate kidney stones or infection). Bladder Hematuria: Suprapubic tenderness (suggestive of cystitis or bladder pathology). Palpable bladder (indicative of urinary retention). Digital rectal examination (DRE) in men may reveal an enlarged prostate. 3. Urinalysis Nephrogenic Hematuria: Dysmorphic RBCs: Irregularly shaped red blood cells (RBCs) suggest glomerular origin. RBC Casts: Pathognomonic for glomerular disease. Proteinuria: Often significant (> 500 mg/day) in glomerular hematuria. White Blood Cells (WBCs): May be present in pyelonephritis or interstitial nephritis. Bladder Hematuria: Isomorphic RBCs: Uniformly shaped RBCs suggest lower urinary tract origin. No RBC Casts: Absence of casts supports a non-glomerular cause. WB

Analysis of hematuria

IF HEMATURIA: Onset •Course • بقاله قد ایه؟ Duration • What increase What decrease • • Color (Red, Tea or Cola Like) • Amount (Mild / Moderate / Severe (Timing (Initial / Terminal / Total Presence Of Blood Clots • (Painful / Painless (Timing initial or terminal or total

What do clots indicate for?

➡️Amount of bloo

What The meaning oh hesitancy?

Delay In The Start Of The Act Of Micturition.

What are the types of incontinence and the meaning of each one ?

Stress Incontinence: Definition: Leakage of urine due to increased intra-abdominal pressure. Causes: Weakness of the pelvic floor muscles or urethral sphincter. Common in women after childbirth or menopause due to hormonal changes. In men, it can occur after prostate surgery. Triggers: Activities that increase abdominal pressure, such as laughing, coughing, sneezing, or lifting heavy objects. Example: A woman leaks urine when she laughs or sneezes. Urge Incontinence: Definition: Leakage of urine due to an overactive bladder or detrusor muscle instability. Causes: Bladder irritation (e.g., from infection, stones, or tumors). Neurological conditions (e.g., multiple sclerosis, Parkinson's disease, stroke). Idiopathic overactive bladder. Symptoms: Sudden, intense urge to urinate, followed by involuntary leakage. Example: A person feels a sudden urge to urinate and cannot reach the bathroom in time. Overflow Incontinence: Definition: Leakage of urine due to overdistension of the bladder, often because it cannot empty properly. Causes: Bladder outlet obstruction (e.g., benign prostatic hyperplasia in men, urethral stricture). Detrusor muscle weakness (e.g., from diabetes or spinal cord injury). Neurogenic bladder (e.g., autonomic neuropathy). Symptoms: Frequent dribbling of urine, feeling of incomplete bladder emptying, and a weak urine stream. Example: A man with an enlarged prostate experiences constant dribbling of urine. Mixed Incontinence: Definition: A combination of stress incontinence and urge incontinence. Causes: Often seen in older women with both pelvic floor weakness and overactive bladder. Symptoms: Leakage with physical activity (stress) and sudden urges to urinate (urge). Example: A woman leaks urine when she coughs (

If cystoscope demanded for patient and revealed bladder cancer , what examinations should be performed before surgery?

➡️ Pv" if female " , PR " if male " , Bimanual and abdominal examination.

What is the staging of bladder carcinoma ?

• T : 1ry tumor -Tis: Carcinoma in situ -T1: invasion of submucosa -T2a: Superficial muscle invasion. -T2b: Deep muscle invasion. -T3a:microscopic invasion of perivesical fat . -T3b:macroscopic invasion of perivesical fat . -T4a: Invasion of near by organ e.g. prostate. -T4b: Fixity to pelvic or abdominal wall. • N : lymph nodes metastases . -No: no node affection -N1: one node metastasis -N2:more the one node metastases -N3 : affection of nodes outside the pelvis ( common iliac nodes) . • M : distal metastasis -Mo: no distal metastasis - M1: presence of distal metastases

What is the mangement for invasive and non muscle invasive bladder carcinoma ?

Feature Non-Muscle-Invasive Bladder Cancer (NMIBC) Primary Treatment TURBT + intravesical therapy (BCG/chemotherapy). .Intravesical Therapy Commonly used (BCG for high-risk NMIBC). Systemic Therapy Rarely needed. Bladder Preservation Not applicable. Surveillance Frequent cystoscopy and urine cytology. FeatureMuscle-Invasive Bladder Cancer (MIBC)Primary TreatmentRadical cystectomy ± neoadjuvant chemotherapy.Intravesical TherapyNot used.Systemic TherapyNeoadjuvant/adjuvant chemotherapy or immunotherapy.Bladder PreservationTrimodality therapy (TURBT + chemoradiation).Surveillance Imaging (CT/MRI) and lab tests.