Lecture on haematuria & urinary tract malignancy for medical students. Encompasses basic sciences, classification,staging and principles of management. Specifically on renal and bladder carcinoma.
3. Definition
• Haematuria = presence of blood in urine
• 40% have significant pathology, about ½ will
be urological malignancy
• All patients with haematuria must be
investigated further
4. Classification
• Macroscopic haematuria
– Alarming symptom
– Initial, terminal or through out
• Microscopic haematuria
– ≥5 RBC/HPF detected upon microscopy of centrifuged sediments of
macroscopically clear urine
– > 48 hours after strenuous exercise
– Glomerular vs. non-glomerular origin
• Dipstick haematuria
– Use of reagent strip to detect peroxidase in urine
– False positive
• Haemoglobinuria, myoglobinuria, oxidising agents, menstruation
– False negative
• High vitamin C intake, nitrite
7. History taking – salient features
Feature Reasoning
Age Young – intrinsic renal pathology
Older – malignancy
Gender Male – malignancy
Female – infection
Occupation Dye or rubber industries
Social Cigarette
Drugs Anti-platelets, anti-coagulants, cyclophosphamide
Family history Stone, malignancy, PCKD
Misc Pelvic irradiation
13. • Potentially deadly cancer
• Characterised by
– A lack of early warning signs
– Diverse clinical manifestations
– Resistance to radiation and chemotherapy
– Infrequent but reproducible response to
immunotherapy agents (e.g. interferon-α,
interleukin-2)
30. Investigations
• USG KUB
– Evaluate upper tract
– Bladder mass
– TRO other cause of lower abdominal pain, esp. women
• CECT scan thorax, abdomen & pelvis
– Staging
– Extra vesical extension (T), nodal involvement (N), distant
mets (M)
– Thickened bladder wall muscle invasion
– To accurately assess the depth of penetration, CT should
be done before TUR
31.
32. • Cystoscopy
– Gold standard
– Flexible scope under local anaesthesia
• Document location , size, numbers, appearance
• Papillary TCC
– Exophytic frond lesion
– Commonest type of TCC
– Small and non invasive
• Sessile TCC
– Broad base
– Solid lesion
– > tendency to be invasive
– Rigid
• Transurethral resection of bladder tumour (TURBT)
• + intravesicle mitomycin x1
– Destroy circulating intraluminal tumour cells
– Ablate tumour cells on resection bed (chemoresection)
– Reduces recurrence rates up to 13% vs. TURBT alone
33.
34. Presentation
• Haematuria
• Mass in bladder seen in imaging
Investigation
• TURBT + intravesicle mitomycin x1
• Review HPE
Further
management
• Decide either for 2nd look, BCG treatment or
surveillance cystoscopy
• Cystectomy if muscle invasive bladder ca