Passing dark colored urine

Urinary bladder carcinoma
1. Signs & symptoms
  1. Hematuria
    1. Hematuria Physiology
      1. Initial hematuria arises from Urethra ( secondary to inflammation)
      2. Total hematuria arises from: Bladder or upper UT
      3. Terminal hematuria arises from: Bladder neck or prostate urethra
    2. Definition
      1. 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.
    3. Localization of hematuria
      2. Grading Scale
    4. Risk factors
      1. Age
      2. A recent infection
      3. Family history
      4. Certain medications
      5. Strenuous exercise
    5. Differential Diagnosis
  2. Having to urinate more often than usual
  3. Pain or burning during urination
  4. Feeling as if you need to go right away, even when the bladder is not full
  5. Having trouble urinating or having a weak urine stream
  6. Lower back pain on one side
  7. Loss of appetite and weight loss
  8. Feeling tired or weak
  9. Swelling in the feet
  10. Bone pain
2. Histopathology of Bladder Carcinoma
  1. Low grade - The border of the urinary bladder epithelium is seen. There is no invasion to the basement membrane
  2. Papillary Urothelial carcinoma - The papillae have fibro-vascular cores.
  3. Cytology
    1. 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
  4. Shistosomiasis
    1. It often leads to squamous cell carcinoma
    2. Composed of well differentiated malignant squamous cells, with nests of keratinization
    3. In the gut, liver, and blood vessels, there is a presence of granulomas with cercaraei of shistosomas
3. Tumor staging and grading
  2. After T2, a complete bladder resection must be done
  3. Before T2 --> BCG and tumor resection
4. Lab investigations
  1. Intravenous pyelogram
    1. x-ray examination that utilizes insertion of contrast material intravenously via an injection to assess the kidneys, ureters and bladder.
    2. 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.
    3. Indications
      1. kidney stones
      2. Enlarged prostate
      3. Tumors in the kidney, ureters or urinary bladder
      4. Scarring from urinary tract infection
      5. Surgery on the urinary tract
      6. Congenital anomalies of the urinary tract
  2. Prostate specific antigen
    1. 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.
    2. Elevated in men with prostate cancer
    3. Used in conjunction with a digital rectal exam (DRE) to test asymptomatic men for prostate cancer.
  3. Imaging
    1. Radiology
      1. X-ray KUB
      2. IVU
      3. Abdominal U/S
      4. CT & MRI
      5. Angiography
      6. Ascending cystography
      7. Ascending urethrography
    2. Endoscopy
      1. Cystourethroscopy
      2. Ureteroscopy
    3. Renal biopsy
5. Treatment and management
6. Prognosis
  1. Patients at stage 2 and below have better prognosis than stages above stage 2
7. Squamous cell carcinoma. SCC of the urinary bladder is a malignant neoplasm that is derived from bladder urothelium and has a pure squamous phenotype.
Physiology of micturition

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Passing dark colored urine

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