Clinical Presentation

Bladder tumours most commonly present with the painless passage of blood in the urine (haema-turia), sometimes with amorphous clots. This is a serious symptom necessitating immediate urologic investigation, particularly in the adult. Haematuria occurring at the end of micturition

Figure 29.1. Anatomy of the bladder. Reproduced from Hermanek P, Hutter RVP, Sobin LH, Wagner G, Wittekind Ch (eds.). TNM Atlas: illustrated guide to the TNM/pTNM classification of malignant tumours, 4th edition. Springer-Verlag: Berlin and Heidelberg, 1997.

(terminal haematuria) points specifically to pathology in the bladder neck region. There are usually no other symptoms unless there is secondary urinary obstruction and/or infection. Advanced bladder cancer may present with symptoms related to a pelvic mass, lower limb oedema due to lymphatic obstruction, or metastatic disease.

Acute urinary retention is more commonly due to prostatic enlargement than bladder disease. Overdistention causes a constant suprapubic pain relieved instantaneously by the passage of urine. Occasionally, with slowly progressive urinary obstruction and bladder distention, e.g., neurogenic (flaccid) bladder of diabetics, there is no associated pain.

Inflammatory conditions of the bladder, including bacterial infection and interstitial cystitis, often present with intermittent suprapubic discomfort or irritative symptoms of painful urination (dysuria), increased number of episodes of micturition daily (frequency) and a sensation of sudden, strong impulse to void (urgency). Diffuse carcinoma in situ of the bladder may also present in this way.

Bladder calculi may be asymptomatic or present with haematuria. There may be pain associated with intermittent bladder outlet obstruction or symptoms related to secondary infection.

Rarer conditions such as diverticula or urachal remnants are usually asymptomatic, although predisposing to stones and infection. Vesicocolic fistula due to colonic diverticulitis, Crohn's disease or malignancy can present with the unusual symptoms of passage of gas (pneumaturia)

Figure 29.2. Bladder - regional lymph nodes (pelvic nodes below the bifurcation of the common iliac arteries). Reproduced from Hermanek P, Hutter RVP, Sobin LH, Wagner G, Wittekind Ch (eds.). TNM Atlas: illustrated guide to the TNM/pTNM classification of malignant tumours, 4th edition. Springer-Verlag: Berlin and Heidelberg, 1997.

Figure 29.2. Bladder - regional lymph nodes (pelvic nodes below the bifurcation of the common iliac arteries). Reproduced from Hermanek P, Hutter RVP, Sobin LH, Wagner G, Wittekind Ch (eds.). TNM Atlas: illustrated guide to the TNM/pTNM classification of malignant tumours, 4th edition. Springer-Verlag: Berlin and Heidelberg, 1997.

or faecal material (faecaluria) in the urine. Vesicovaginal fistula due to malignancy may result in the passage of urine vaginally.

0 0

Post a comment