What Is Renal Ultrasound
Renal ultrasound is the least invasive way to evaluate the kidneys. It does not require radiation and avoids contrast. It may be used in lower risk patients and those with contrast allergies or poor renal function. Unfortunately, it can miss small kidney stones and tumors. Also, it will not detect tumors in the ureter unless they are causing a blockage leading to hydronephrosis.
What Happens During A Cystoscopy
During flexible cystoscopy, the patient lies on their back and an anesthetic gel is passed into the urethra to make the area numb. Once the local anesthetic is working, the doctor inserts the cystoscope through the urethra and then into the bladder. Sterile water may be injected through the cystoscope into the bladder to help make the inner surface of the bladder easier to see. The cystoscope is moved around inside the bladder so that the entire inner surface can be examined.
During rigid cystoscopy, the procedure is similar to flexible cystoscopy but as the patient is usually under general anesthesia they will not be aware of any associated physical sensations. If the doctor sees an abnormal area, biopsies will be taken or a transurethral resection of bladder tumor may be carried out to remove the suspected tumor. The extracted tissues are then sent to a laboratory to be tested for cancer.
New And Experimental Treatments
Several new treatments may prove useful in treating bladder cancer. Photodynamic therapy, used in early stage cancers, uses a laser light to activate a chemical that kills cancer cells. Some gene therapies use lab-created viruses to fight cancer. And targeted therapies aim to control the growth of cancer cells. You may be eligible to participate in a clinical trial of these or other cutting-edge treatments.
21) Carol & Mike Werner / Visuals Unlimited / Corbis
American Urological Association: “Bladder Cancer.”
American Urological Association Foundation: “Hematuria.”
Journal of the American Medical Association: Association Between Smoking and Risk of Bladder Cancer Among Men and Women.
Occupational & Environmental Medicine: Bladder cancer among hairdressers: a meta-analysis.
British Journal of Cancer: Occupation and bladder cancer: a cohort study in Sweden.
National Cancer Institute: “Staging,” “Bladder Cancer Treatment,” “Drugs Approved for Bladder Cancer,” “SEER Stat Fact Sheets: Bladder.”
NIH Research Matters: “Smoking and Bladder Cancer.”
ScienceDaily: “Cigarette Smoking Implicated in Half of Bladder Cancers in Women Bladder Cancer Risk from Smoking Is Higher Than Previously Estimated, Study Confirms.”
Stanford Cancer Institute: “Information About Bladder Cancer.”
World Health Organization: “Tobacco Free Initiative — Cancer.”
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Are There Any Risks Associated With Cystoscopy
Cystoscopy is usually a safe procedure and serious complications are uncommon. The most frequent complication is urinary tract infection . UTIs may require antibiotic treatment, so it is important to seek medical help if urinary symptoms persist for longer than expected following a cystoscopy or if other UTI symptoms develop . Less commonly, patients may be temporarily unable to pass urine after a cystoscopy and it may be necessary for a catheter to be inserted into the bladder to enable emptying. There is also a small risk that the urethra or bladder may be damaged by the cystoscope and subsequently require remedial surgery.
In patients who undergo rigid cystoscopy, side effects associated with anesthesia may be experienced. Common side effects of general anesthesia include nausea, vomiting, sore throat, muscle aches, itching, shivering, and sleepiness side effects most frequently associated with spinal anesthesia include itchiness, a drop in blood pressure, and temporary difficulty passing urine .
Recent Improvements In The Sonographic Detection Of Ovarian Cancer
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What Is Enhanced Cystoscopy
Many doctors now have enhanced cystoscopy tools to help doctors see a difference between healthy tissue and cancer. Theyre able to see bladder cancer tumors better at the time of bladder biopsy or TURBT . It can help doctors find easily missed tumors.
One method uses a special medicine your doctor places inside the bladder. Any cancer cells absorb the medicine. During cystoscopy, the urologist shines a special blue light on the bladder. With this blue light, the tumors that absorbed the medicine glow bright pink.
Bladder tumors tend to have an increased blood supply to feed them. The other enhanced cystoscopy method changes wavelengths of light from the cystoscope to find any areas with more blood vessels to better locate any tumors.
Ask your doctor if they will used enhanced cystoscopy the next time they are checking your bladder or doing a TURBT.
Learn more about bladder cancer by perusing our Glossary of Terms.
Tests For Bladder Cancer
Bladder cancer is often found because of signs or symptoms a person is having. Or it might be found because of lab tests a person gets for another reason. If bladder cancer is suspected, exams and tests will be needed to confirm the diagnosis. If cancer is found, more tests will be done to help find out the extent of the cancer.
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Liver/ Spleen Involvement In Schistosomiasis
his patient is a known case of Bilharziasis and ultrasound showed hepatosplenomegaly with increased echogenicity of the periportal regions of the portal veins suggesting periportal fibrosis.Fibrosis of the periportal regions of the liver is a known complication of hepatic involvement in schistosomiasis. Ultrasound images are courtesy of Ravi Kadasne, MD, UAE.
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Do Benign Tumors Need To Be Removed
It depends, says Dr. Guru. Benign bladder masses usually grow very slowly and will not spread to other tissues or organs in the body. In some cases, we will just monitor patients on a regular basis. However, some benign masses can bleed or grow very large and cause problems by taking up too much space in your bladder or pressing on other organs in your body. In that case, we usually remove or treat benign masses, using a TURBT procedure.
If you are ever unsure about your bladder symptoms or your bladder tumor diagnosis, we recommend an appointment with our multidisciplinary cancer care experts at Roswell Park.
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Bladder Cancer Treatment: Surgery
Early-stage cancers are most commonly treated by transurethral surgery. An instrument with a small wire loop is inserted through the urethra and into the bladder. The loop removes a tumor by cutting or burning it with electrical current, allowing it to be extracted from the bladder.
Partial and Radical Cystectomy
Partial cystectomy includes the removal of part of the bladder. This operation is usually for low-grade tumors that have invaded the bladder wall but are limited to a small area of the bladder. In a radical cystectomy, the entire bladder is removed, as well as its surrounding lymph nodes and other areas that contain cancerous cells. If the cancer has metastasized outside of the bladder and into neighboring tissue, other organs may also be removed such as the uterus and ovaries in women and the prostate in men.
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Q: How Is Cysview Administered And How Does It Work
Medical staff begin by inserting a small amount of the Cysview solution into the bladder and cancer cells located in the superficial layers of the bladder, if present, begin absorbing the medication. The surgeon then uses a cystoscope using white light, to visualize the bladder wall, which may find larger, more easily apparent, tumors.
After switching the cystoscope to cast a blue light on the bladder wall, Cysview-infused tumors or lesions, including small ones, will appear in vivid pink, while the surrounding healthy tissue remains blue. The striking color differences help surgeons to detect, biopsy, and surgically remove just cancerous areas, while keeping healthy tissue intact.
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What Is Chemotherapy For Bladder Cancer
Patients who are diagnosed with metastatic bladder cancer are usually treated with chemotherapy. Chemotherapy may also be used in cases of locally advanced bladder cancer in an attempt to decrease the chances of the cancer coming back after radical cystectomy. This is adjuvant chemotherapy. Another strategy entails administering neoadjuvant chemotherapy by giving these medications before radical cystectomy in an attempt to improve the results of surgery and decrease the size of the tumor before the operation.
Chemotherapy has the potential to control metastatic bladder cancer and increase the chances of cure when used in a neoadjuvant or adjuvant setting along with surgery. However, chemotherapy has its own set of side effects that some individuals find intolerable.
The time-honored chemotherapy regimen for bladder cancer is the MVAC. It is a combination of four medications given in cyclical form.
Oncologists currently prescribe MVAC in a dose dense fashion. This means the patient takes the drugs more frequently than was previously done in the accepted treatment schedule, as well as taking growth factors to help the blood counts to recover faster from the effects of the chemotherapy drugs. The older schedule for MVAC therapy is no longer recommended according to the National Comprehensive Cancer Network.
Transurethral Resection Of Bladder Tumor
If an abnormal area is seen during a cystoscopy, it needs to be biopsied to see if it’s cancer. A biopsy is when tiny pieces of the abnormal-looking tissue are taken out and tested for cancer cells. If bladder cancer is suspected, a biopsy is needed to be sure of the diagnosis.
The procedure used to biopsy an abnormal area is a transurethral resection of bladder tumor , also known as just a transurethral resection . During this procedure, the doctor removes the tumor and some of the bladder muscle around the tumor. The removed samples are then sent to a lab to look for cancer. If cancer is found, testing can also show if it has invaded the muscle layer of the bladder wall. For more on how this procedure is done, see Bladder Cancer Surgery.
Bladder cancer can sometimes start in more than one area of the bladder . Because of this, the doctor may take samples from many different parts of the bladder, especially if cancer is strongly suspected but no tumor can be seen. Salt water washings of the inside the bladder may also be collected and tested for cancer cells.
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Cystoscopy Techniques For Women
Cystoscopy in women can be performed as described for men, using the flexible cystoscope, or a rigid cystoscope may be used because of the relatively straight female urethra.
In actuality, the female urethra also dips slightly down therefore, placement of the rigid scope is more comfortable if the scope is pointed dorsally as it enters the urethra and then redirected ventrally prior to entering the bladder neck, following the natural, slightly upward curve of the urethra.
In order to remove the obturator without spilling urine, the scope may be placed gently against the back wall of the bladder while switching the obturator for a lens, although the surgeon must be careful to avoid causing irritation that could mimic carcinoma in situ . Note that the trigone is the most sensitive part of the bladder, so placing the scope against the back wall instead of the trigone is requisite.
Once the 70° lens is in place, the bladder may be swept similarly by angling the surgeon’s end of the scope away from the side of interest. In doing so, the scope essentially ends up creating a conical motion, with the tip or pivot point being the urethra. The 30° lens is then able to visualize the entire bladder with effort, but the 70° lens can easily visualize the entire bladder unless the bladder is overfilled.
Digital chip endoscopy may be performed as easily in women as it is in men.
What Are Bladder Tumors
Bladder tumors are abnormal growths that occur in the bladder. If the tumor is benign, its noncancerous and wont spread to other parts of your body. This is in contrast to a tumor thats malignant, which means its cancerous.
There are several types of benign tumors that can develop within the bladder.
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What Is Bladder Cancer
Cancer can start any place in the body. Cancer that starts in the bladder is called bladder cancer. It starts when cells in the bladder grow out of control and crowd out normal cells. This makes it hard for the body to work the way it should.
Cancer cells can spread to other parts of the body. For instance, cancer cells in the bladder can travel to the bone and grow there. When cancer cells spread, its called metastasis.
Cancer is always named for the place where it starts. So when bladder cancer spreads to the bone , it’s still called bladder cancer. Its not called bone cancer unless it starts in the bone.
What Should I Expect After A Cystoscopy
You may have belly pain, blood-tinged urine or pain when peeing for the first day or two after the procedure. You may also feel like you need to pee often and urgently. These problems should fade within 48 hours.
Your doctor may prescribe an antibiotic to prevent infection. To ease side effects, you can:
- Apply a warm, damp washcloth over the urethral opening or relax in a warm bath.
- Drink several glasses of water every day to flush out the bladder.
- Take an over-the-counter pain reliever, such as nonsteroidal anti-inflammatory drugs .
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Bladder Cancer Clinical Trials
What about Clinical Trials?
You may hear about clinical trials for your bladder cancer. Clinical trials are research studies that test if a new treatment or procedure is safe and effective.
Through clinical trials, doctors find new ways to improve treatments and the quality of life for people with disease. Trials are available for all stages of cancer. The results of a clinical trial can make a major difference to patients and their families. Please visit our clinical trials research webpage to learn more.
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Expert Review And References
- Al-Ahmadie H, Lin O, Reuter VE. Pathology and cytology of tumors of the urinary tract. Scardino PT, Lineham WM, Zelefsky MJ, Vogelzang NJ . Comprehensive Textbook of Genitourinary Oncology. 4th ed. Philadelphia: Wolters Kluwer/Lippincott Williams & Wilkins 2011: 16:295-316.
- American Urological Association. Non-Invasive Urothelial Neoplasms. .
- Humphrey PA, Moch H, Cubilla AL, Ulbright TM, Reuter VE. The 2016 WHO Classification of Tumours of the Urinary System and Male Genital Organs – Part B: Prostate and Bladder Tumours. European Urology. 2016: .
- Preminger GM, Glenn JF. Urinary calculi. Porter RS . Merck Manual Professional Edition. Kenilworth, NJ: Merck Sharp & Dohme Corp. 2018: .
- US National Library of Medicine. MedlinePlus Medical Encyclopedia: Urinary Tract Infection – Adults. 2018: .
- WebMD LLC. Bladder cancer workup. 2012: .
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Endoscopic Teflon Or Deflux Gel Treatment For Vesico
This patient shows an echogenic mound in the left vesico-ureteric junction. The Color Doppler image shows a ureteric jet emerging from this region suggesting that the left distal ureteric orificeis patent. This patient had a history of vesico-ureteric reflux. This was corrected by a Teflon gel injected in the submucosal part of the left VUJ viathe endoscopic route. There are 5 grades of vescio-ureteral reflux. Grade-1: the VUR reaches below the renal pelvis. Grade-2: VUR reaches up to the renal pelvis without causing dilation of thepelvis. Grade-3: There is mild to moderate dilation of the renal pelvis and ureter. Grade-4: Moderate dilation of renal pelvis, ureter and calyces is present. Grade-5: Gross dilation of pelvicalyceswith tortuous and dilated ureter. Endoscopic deflux or Teflon gel injection is used for correcting of VU reflux from grade-2 to grade-5. the gel causes a small mound to form in the submucosal part ofthe distal ureteral orifice resulting in a kind of valve formation preventing the reflux of urine up the ureter. Teflon is now being replaced by Deflux gel as the preferred material for thisprocedure. Ultrasound images of endoscopic Teflon gel injection are courtesy of Dr. ravi Kadasne, MD, UAE.
Q: Is Cysview With Blue Light Cystoscopy Safe
Clinical tests have shown that BLCC is safe and well-tolerated. However, no surgical procedure is free of any risk, so you should consult your doctor regarding the risks and benefits of this procedure for your individual circumstances.
Most people are ready to go home shortly after a routine procedure. However, this will depend on the extent of your disease and how much tissue may have been removed from your bladder. Your doctor will advise you on how much rest and care you will need afterward.
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Urinary Bladder Wall Trabeculation In A Case Of Lower Urinary Tract Obstruction
Sonography of the urinary system was done on this elderly male patient having lower urinary tract symptoms. Ultrasound images show evidence of trabeculation of the urinary bladder. This is seen asfolds of hypertrophied bladder mucosa and bladder smooth muscle. There is also evidence of bilateral moderate hydronephrosis . The cause of Lower urinary tract obstruction appears tothe enlarged prostate with intravesical enlargement of the median lobe . The fourth image shows significant post-voiding residual urine in theurinary bladder .
Bladder trabeculation has been graded from 0 to 3 as:
grade 0- no trabeculation.
grade1- mild: area affected is less than 1/2 of the bladder and depth of trabeculation less than 5 mm.
grade2- moderate: area affected is greater than 1/2 of the bladder and depth of trabeculation is 5 to 10 mm.
grade 3- severe: area affected is greater than 1/2 of the bladder and depth of trabeculation is greater than 10 mm.
All images by Joe Antony, MD, using a Toshiba Nemio-XG ultrasound system.
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