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Australian Family Physician Apr 2011Over 2000 cases of bladder cancer were diagnosed in Australia in 2005. Bladder cancer is a relatively common disease with high morbidity if left untreated. Bladder...
BACKGROUND
Over 2000 cases of bladder cancer were diagnosed in Australia in 2005. Bladder cancer is a relatively common disease with high morbidity if left untreated. Bladder cancer is categorised as either 'nonmuscle invasive bladder cancer' or 'muscle invasive bladder cancer'. Treatment varies significantly for each type.
OBJECTIVE
This article provides an update on the presentation of bladder cancer, its risk factors, investigations and treatment, and discusses the role of chemotherapy as a neoadjuvant and adjuvant treatment.
DISCUSSION
Bladder cancer most commonly presents with microscopic or macroscopic haematuria. Evaluation is required of all patients with macroscopic haematuria, patients with persistent microscopic haematuria, and at risk patients with a single episode of microscopic haematuria. Evaluation consists of imaging, urine cytology and cystoscopy. Nonmuscle invasive bladder cancer patients can undergo tumour resection with adjuvant intravesical treatments, while muscle invasive bladder cancer patients are optimally treated with cystectomy and urinary diversion.
Topics: Australia; Humans; Neoplasm Staging; Risk Factors; Urinary Bladder Neoplasms
PubMed: 21597531
DOI: No ID Found -
Archivos Espanoles de Urologia Jun 2021To report the diagnostic accuracy and liability of the instrumentalized urine cytology in the preliminary study of monosyntomatic gross haematuria.
OBJECTIVE
To report the diagnostic accuracy and liability of the instrumentalized urine cytology in the preliminary study of monosyntomatic gross haematuria.
METHODS
A retrospective, descriptive and analytic study of the patients that complained of macroscopic hematuria at the one-stop clinic between 2011 and 2018. The complementary tests requested were: kidney/bladder ultrasounds, urethrocystoscopy and urinary instrumentalized cytology. All the urine cytology samples were examined by the same pathologist.
RESULTS
1122 patients were reviewed with ultrasonography and cystoscopy. Bladder tumor was detected in 354 patients (31.5%) and other urological malignancies were found in 33 cases (2.9%). Urinary instrumentalized cytologies were collected in 804 patients (71.4%), being positive in 236 cases (29.4%). Sensitivity and specificity of urinary cytology for urothelial tumor detection were 55.1% and 85.7%, respectively. Cytology was positive in 181 patients (52.1%) with visible bladder tumors through cystoscopy, in 7 patients (0.87%) without visible bladder tumors. In 433 patients with ultrasonography and cystoscopy both negative, urine cytology was performed with a negative result (38.6%).
CONCLUSION
The usefulness of instrumentalized urinary cytology to diagnose urothelial tumors is restricted in terms of monosymptomatic gross haematuria one stop clinic. It allows the diagnosis of a very limited number of cases tumors and leaves a significant number of them out. In case of gross hematuria and negative imaging, urine cytology can be requested as a differed complementary.
Topics: Cystoscopy; Hematuria; Humans; Retrospective Studies; Sensitivity and Specificity; Urinary Bladder Neoplasms; Urine; Urologic Neoplasms
PubMed: 34080566
DOI: No ID Found -
Bladder (San Francisco, Calif.) 2020Malakoplakia is a chronic inflammatory condition that affects multiple systems, most commonly the urogenital tract. Its clinical presentation is often non-specific, but...
Malakoplakia is a chronic inflammatory condition that affects multiple systems, most commonly the urogenital tract. Its clinical presentation is often non-specific, but is typically characterized by recurrent urinary tract infections and haematuria. We report a rare case of intravesical malakoplakia mimicking an aggressive transitional cell carcinoma both in its clinical presentation and in its macroscopic appearance on cystoscopy in an 82-year patient, the oldest reported case in the literature. Malakoplakia has been described in the literature as a benign disease process presenting typically in younger patients. This case demonstrates its ability to cause obstructive uropathy and affect elderly patients. Thus, this case serves as a reminder to consider malakoplakia as a differential in the evaluation of suspected bladder malignancy in patients of all ages.
PubMed: 32934968
DOI: 10.14440/bladder.2020.818 -
Iranian Journal of Public Health Aug 2015A 6.5 yr old girl was admitted with a category of clinical signs and symptoms including recurrent gross hematuria, abdominal pain, and fever. After different...
A 6.5 yr old girl was admitted with a category of clinical signs and symptoms including recurrent gross hematuria, abdominal pain, and fever. After different examinations including genetic analysis, the disease was diagnosed as Familial Mediterranean fever (FMF). It is suggested to consider FMF as a rare cause of recurrent gross hematuria, which is responsive to colchicine treatment.
PubMed: 26587479
DOI: No ID Found -
International Journal of Surgery Case... Dec 2022The most common causes of hematuria are lower urinary tract infections, especially of the bladder, urolithiasis, urogenital tumors or benign prostatic hyperplasia;...
INTRODUCTION
The most common causes of hematuria are lower urinary tract infections, especially of the bladder, urolithiasis, urogenital tumors or benign prostatic hyperplasia; consequently, this condition presents the greatest clinical challenge due to its broad clinical spectrum, hematuria is an atypical form of presentation of testicular tumors, with very few cases reported in the literature, reaffirming the importance of a complete examination when approaching hematuria in the emergency department.
CASE PRESENTATION
We present a case of a 31-year-old patient who presented to the emergency department with macroscopic hematuria of 5 weeks of evolution, showing on examination a mass in the left testicle. Imaging studies showed bilateral pulmonary metastatic lesions and retroperitoneal lymph node activity with a retrocaval conglomerate infiltrating the left ureter, for which a radical left orchiectomy and multiple procedures were performed to resolve the hematuria.
DISCUSSION
Macroscopic hematuria in adolescents or young adults is an infrequent cause of admission to the Emergency Department with a large list of differential diagnoses both benign and malignant so it is necessary to perform exhaustive studies in its approach, when young patients present with a painless testicular mass, it is important to keep testicular cancer within the differential diagnoses, metastatic disease is a rare form of presentation in this type of tumors. The relevance of this clinical case lies in the fact that hematuria was the main symptom that brought the patient to the emergency department, so we must not forget that macroscopic hematuria should be extensively studied.
CONCLUSION
When approaching a patient with macroscopic hematuria, the clinical history and physical examination is extremely important to provide the best possible care and focus the treatment properly.
PubMed: 36434876
DOI: 10.1016/j.ijscr.2022.107799 -
Clinical Kidney Journal Dec 2023Hematuria-either macroscopic hematuria or asymptomatic microscopic hematuria-is a clinical feature typical but not specific for immunoglobulin A nephropathy (IgAN). The... (Review)
Review
Hematuria-either macroscopic hematuria or asymptomatic microscopic hematuria-is a clinical feature typical but not specific for immunoglobulin A nephropathy (IgAN). The only biomarker supported by the Kidney Disease: Improving Global Outcomes group as a predictor of progression, identifying patients needing treatment, is proteinuria >1 g/day persistent despite maximized supportive care. However, proteinuria can occur in the setting of active glomerulonephritis or secondary to sclerotic renal lesions. Microscopic hematuria is observed in experimental models of IgAN after IgA-IgG immunocomplex deposition, activation of inflammation and complement pathways. Oxidative damage, triggered by hemoglobin release, is thought to contribute to the development of proteinuria and progression. Despite being a clinical hallmark of IgAN and having a rational relationship with its pathophysiology, the value of microscopic hematuria in assessing activity and predicting outcomes in patients with IgAN is still debated. This was partly due to a lack of standardization and day-to-day variability of microhematuria, which discouraged the inclusion of microhematuria in large multicenter studies. More recently, several studies from Asia, Europe and the USA have highlighted the importance of microhematuria assessment over longitudinal follow-up, using a systematic approach with either experienced personnel or automated techniques. We report lights and shadows of microhematuria evaluation in IgAN, looking for evidence for a more consistent consensus on its value as a marker of clinical and histological activity, risk assessment and prediction of treatment response. We propose that hematuria should be included as part of the clinical decision-making process when considering when to use immunosuppressive therapy and as part of criteria for enrollment into clinical trials to test drugs targeting the inflammatory reaction elicited by immune pathway activation in IgAN.
PubMed: 38053974
DOI: 10.1093/ckj/sfad232 -
Renal Failure Dec 2021The relationship between hematuria, a typical presentation of immunoglobulin A nephropathy (IgAN), and long-term adverse prognosis of these patients is still... (Meta-Analysis)
Meta-Analysis
The relationship between hematuria, a typical presentation of immunoglobulin A nephropathy (IgAN), and long-term adverse prognosis of these patients is still controversial. This meta-analysis aims to clarify the effect of hematuria on renal outcomes in IgAN. Observational cohort studies reporting associations between various forms of hematuria and renal outcomes among IgAN patients were identified from the PubMed and Embase databases. The pooled adjusted risk ratios (RRs) were computed with random effects models. Thirteen studies encompassing 5660 patients with IgAN were included. Patients with initial hematuria did not have a significantly increased risk of developing end-stage renal disease (ESRD) compared with those without hematuria (RR, 1.32; 95% CI, 0.87-2.00; = .19). However, initial microscopic hematuria was associated with an 87% increase in the risk of ESRD (RR, 1.87; 95% CI, 1.40-2.50; < .001), while macroscopic hematuria was associated with a 32% decrease in the risk of ESRD (RR, 0.68; 95% CI, 0.58-0.79; < .001). Additionally, persistent hematuria might be an independent risk factor for ESRD or a 50% decline in eGFR. Among IgAN patients, hematuria, including initial microscopic hematuria and even persistent hematuria, was possibly associated with renal progression and ESRD. However, independent of other classical predictors, initial macroscopic hematuria might be a protective factor for IgAN.
Topics: Disease Progression; Glomerular Filtration Rate; Glomerulonephritis, IGA; Hematuria; Humans; Kidney Failure, Chronic; Risk Factors
PubMed: 33685345
DOI: 10.1080/0886022X.2021.1879852 -
Kidney & Blood Pressure Research 2015Information regarding the clinical and histological prognostic factors of IgA nephropathy (IgAN) is mostly derived from patients in whom diagnostic renal biopsies were...
BACKGROUND/AIMS
Information regarding the clinical and histological prognostic factors of IgA nephropathy (IgAN) is mostly derived from patients in whom diagnostic renal biopsies were performed because their proteinuria levels were higher than 1-2 g/d. The clinicopathological features and outcomes of IgAN patients presenting with normal blood pressure, normal renal function, hematuria and minimal or no proteinuria are not well described. We therefore conducted a study of the clinicopathological features and outcomes in IgAN patients with these characteristics.
METHODS
The clinical, laboratory, and pathological manifestations and long-term outcomes of all IgAN patients with the above-mentioned characteristics were collected. The relationships between renal pathology, injury, long-term outcomes and clinical factors were studied, and the risk factors of IgAN were analyzed using multivariate logistic regression.
RESULTS
Of all of the renal biopsy cases, IgAN with the above features accounted for 8.9%. Among these patients, 67.2% (253) showed simultaneous hematuria and proteinuria, 23.1% (87) showed only hematuria, and 9.7% (36) showed only proteinuria. Additionally, 33.8% (127) patients showed macroscopic hematuria and 65.1% (245) had a prodromal infection. Regarding renal pathological changes, 45.5% (171) of the patients were unexpectedly classified as Grade II to IV (Hass classification). Proteinuria at the time of renal biopsy was an independent predictor of more severe renal pathological injury. After a median follow-up of 75 months, 61 (16.2%) patients experienced adverse events. Among these patients, 28 (7.45%) exhibited hypertension, 22 (5.85%) presented proteinuria levels >1 g/24 h, and 11 (2.9%) developed impaired renal function.
CONCLUSIONS
Severe renal histological injury may be observed in some IgAN patients with benign clinical characteristics. Proteinuria is an independent predictor of severe renal pathological injury in IgAN patients with mild proteinuria. More severe pathological injury (> Grade II, Hass classification) are predictors of poor prognosis.
Topics: Adult; Biopsy; Disease Progression; Female; Glomerulonephritis, IGA; Hematuria; Humans; Kidney; Male; Proteinuria; Retrospective Studies; Risk Factors; Treatment Outcome; Young Adult
PubMed: 25924707
DOI: 10.1159/000368495 -
Journal of B.U.ON. : Official Journal... 2013Small cell carcinoma of the urinary bladder (SCC-BL) is an extremely rare malignancy, accounting for < 1% of all bladder tumors. Its prognosis is very poor because of... (Review)
Review
PURPOSE
Small cell carcinoma of the urinary bladder (SCC-BL) is an extremely rare malignancy, accounting for < 1% of all bladder tumors. Its prognosis is very poor because of its highly aggressive behavior and high metastatic potential. This study aimed to update the management and outcome of SCC-BL by searching the relevant international literature.
METHODS
Relevant studies were identified by searching MEDLINE and the Cochrane Central Register of Controlled Trials using a combination of terms such as small cell carcinoma, bladder cancer, therapeutic approach, radical cystectomy, radiation therapy and chemotherapy. Additional papers were identified from reviewing references of relevant articles.
RESULTS
Previously published series have shown that SCC-BL has a significant male predominance, occurs mainly during the 7th and 8th decade of life and macroscopic hematuria is the most common presenting symptom. According to the most important studies, cystectomy alone seems not to be efficient enough for the management of the disease. On the other hand, radiation therapy when combined with chemotherapy is highly effective with increased survival rates.
CONCLUSION
Poor prognosis and rarity render disease management complicated. A definitive treatment is not yet established but combined therapy with systemic platinum-based chemotherapy and adjuvant local radiotherapy seems to be the most effective therapeutic approach for limited-stage SCC-BL. Further research is required in order to clarify whether prophylactic cranial irradiation (PCI) should be performed on a regular basis.
Topics: Aged; Aged, 80 and over; Antineoplastic Combined Chemotherapy Protocols; Brain Neoplasms; Carcinoma, Small Cell; Chemotherapy, Adjuvant; Cranial Irradiation; Cystectomy; Female; Hematuria; Humans; Male; Radiotherapy, Adjuvant; Risk Factors; Time Factors; Treatment Outcome; Urinary Bladder Neoplasms
PubMed: 23613409
DOI: No ID Found -
Palliative Medicine Reports 2020To assess the efficacy and toxicity profiles of palliative radiation therapy (RT) for macroscopic hematuria (MH) caused by urothelial cancer. A total of 25 urothelial...
To assess the efficacy and toxicity profiles of palliative radiation therapy (RT) for macroscopic hematuria (MH) caused by urothelial cancer. A total of 25 urothelial cancer patients with MH who underwent palliative RT between 2008 and 2018 were analyzed in this retrospective study. The hematuria-free survival (HFS) time was defined as the period from complete resolution of MH to the recurrence of MH, death, or the last follow-up examination. Adverse events were classified according to the Common Terminology Criteria for Adverse Events version 4.0. By the end of the median follow-up duration of 90 days (11-886 days), complete resolution of MH had been achieved in 22 patients (88%), and the median interval between the start of RT and resolution of MH was 9 days (2-179 days). Of the 22 patients in whom the symptom resolved, 9 (41%) developed recurrent MH, and the median time to relapse of MH was 129 days (30-692 days). The median RT dose was 30 Gy (20-40 Gy). Nine (36%) patients received a blood transfusion before the RT. The three-month HFS rate was 52.1%. There was a significant difference in the three-month HFS rate between patients with and without a history of pretreatment blood transfusion (HFS rate: 34.6% vs. 61.5%, = 0.03). Grade 2 urinary tract pain and grade 3 diarrhea were seen in one patient each. Palliative RT appeared to be effective with limited toxicities for urothelial cancer patients with MH.
PubMed: 34223477
DOI: 10.1089/pmr.2020.0027