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A little blood in the urine - What ’ s the big deal ?
Hematuria is the presence of blood in the urine and may be either visible ( Gross ) or invisible ( Microscopic ). There are multiple causes for hematuria . Proper assessment by a clinician is needed to ensure serious conditions are not overlooked . The most common cause of hematuria associated with painful urination in the outpatient setting is UTI in both men and women ( more common in women ). These often settle with a course of antibiotics and are usually not evaluated further . Specialist referrals are not needed unless conditions are recurrent and / or persistent .
The so-called “ Painless hematuria ” is a sinister symptom in Urology , often needing early assessment . However , these patients typically present much later due to the lack of symptoms . Kidney or bladder cancers are usually found in painless hematuria patients . A significant number of patients have been diagnosed with kidney or bladder cancer only after being referred to a Urologist . There are two distinct forms of bladder cancer : Superficial Bladder Cancer , -confined to the lining of the bladder ( NonMIBC ) and Muscle Invasive Bladder Cancer ( MIBC ). Both types are very different from each other in that the treatment of the first is endoscopic ( minimally invasive surgery- Bladder preserving ), and the second calls for
Dr . Arumuga Kumar Rajendram , Consultant Urologist , ParkCity Medical Centre
complete bladder removal and urinary diversion ( major surgery ) to be able to achieve a cure . Bladder tumors are typically Urothelial or Transitional cell cancers ( TCC ) and can also happen in the ureters and lining of the kidneys . Most importantly , Superficial Bladder cancer , if left untreated will ultimately progress to Muscle invasive disease with time . A timely assessment , aggressive endoscopic management , and intravesical therapies can acheive cure with minimal morbidity to the patient . Retrospective bladder cancer studies locally have found an average delay of 6 months from the first onset of hematuria until cystoscopy at a urology referral center . This means that late diagnosis and progression to muscle invasive cancer could happen in this waiting period . Some patients do present with advanced cancer when a surgical cure is not possible .
In conclusion , it suffices to say that not all cases of blood in urine are serious , but neglecting it would be putting the patient at risk of missing potentially worrying or life-threatening conditions . Simple procedures like an ultrasound and cystoscopy can pick up on early cancers which are much easier to treat and cure .
Upper pole kidney tumour ( removable surgically )
Large muscle invasive bladder tumour ( complete bladder removal needed )
Imaging of the renal tract with an ultrasound or Contrasted CT scan is performed together with a diagnostic Cystoscopy to visualize the interior of the bladder in these patients to detect abnormalities or tumors that do not show up in the scans . A higher index of suspicion is needed in smokers and workers in paint or dye industries when they present as these are occupational risk factors .
Many other causes of hematuria are - stones , kidney infection or inflammation ( glomerulonephritis ), trauma , exercise-induced hematuria , bleeding disorders , anticoagulation therapy , previous radiotherapy , and from the prostate gland in men .
Upon full assessment of the patient , if hematuria persists , and no urological cause is found it is then termed benign microscopic hematuria . A nephrologist will undertake to follow up with these patients and consider further tests as they deem necessary .
Early small / flat bladder cancer that can be missed on imaging but found on cystoscopy
Typical bladder cancer removable endoscopically
GlobalHealthAsiaPacific . com ISSUE 5 | 2024
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