Tag Archive | "cystoscopy"

High-grade Bladder Cancer Patients Not Receiving Recommended Care

In a recently published study in Cancer, researchers at UCLA’s Jonsson Comprehensive Cancer Center found that just one in 4,545 people with high-grade noninvasive bladder cancer was treated according to the comprehensive care guidelines set by the American Urological Association and the National Comprehensive Cancer Network.

The cells in a patient with high-grade cancer show greater abnormality than cells in a patient with a low-grade tumor.  Guidelines for high-grade cancer require an initial injection of chemotherapy drugs directly into the bladder to kill cancer cells and an intense follow-up surveillance schedule that involves using a scope to assess the bladder (cystoscopy) and urine testing (cytology) four times a year.  This chemotherapy shot should be followed by a six-week course of Bacillus Calmette-Guerin (BCG) treatment, which creates an inflammatory response, causing the body to attack the cancer.  Also recommended is imaging of the upper urinary tract with a CT scan, MRI scan, or renal ultrasound at diagnosis and every two years.

Researchers found that compliance with these guidelines had more to do with the doctors treating the patients than with the patients’ age, race, or economic status.  They concluded that the guidelines my not be reaching urologists at community hospitals, which is where the majority of patients receive treatment.

The authors’ suggestions for increasing compliance rates included modifying reimbursement rates and conducting more research to identify factors inhibiting comprehensive treatment.  Karim Chamie, M.D., a postdoctoral fellow in urologic oncology and health services and the lead author of the study, believes that meeting the recommended guidelines for high-grade bladder cancer patients will significantly reduce the mortality rate.

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Tests You May Need for Urinary Incontinence

An accurate diagnosis of your urinary incontinence is very important because treatment based on an incorrect diagnosis may not help your incontinence and could even make it worse.

To diagnose the cause of your urinary incontinence, your doctor will do one or a combination of the following common tests and processes for urinary incontinence -

Medical history. Your doctor will ask you about your symptoms and habits, for example, how often you need to urinate, when you leak urine, how much fluid and what kinds of fluids you drink, and whether you have any other symptoms along with incontinence. Your answers will provide clues about the cause of your incontinence. Always be completely honest with your healthcare provider about your condition.

Physical exam including a pelvic exam. At this point, your doctor may also ask you to cough vigorously while you are standing or bear down as your doctor examines you and watches for loss of urine.  This is to check for stress incontinence.

Urinalysis and urine culture. A sample of your urine is sent to a laboratory, where it’s checked for signs of infection, traces of blood or other abnormalities.

Blood test. Your doctor may have a sample of your blood drawn and sent to a laboratory for analysis. Your blood is checked for various chemicals and substances related to causes of incontinence.

Your doctor may ask you to keep a bladder diary for several days (3-7 days). You record how much you drink, what you drink, how often and how much you urinate and leak and whether you had an urge to urinate.

If further information is needed, other procedures that may be done include:

Pelvic ultrasound. Ultrasound also may be used to view other parts of your urinary tract or genitals to check for abnormalities.

Bladder stress test and Bonney test. For the bladder stress test, your doctor will insert fluid into your bladder and then check for leaking after asking you to cough. The Bonney test is similar to the bladder stress test except the bladder neck is lifted slightly with a finger or instrument inserted into your vagina while the bladder stress is applied.

Pad test. A pad test can show how much urine you are passing and how often throughout the day. This is helpful when incontinence cannot be triggered during an exam.

Urodynamic testing. These tests measure pressure in your bladder when it’s at rest and when it’s filling. A doctor or nurse inserts a catheter into your urethra and bladder to fill your bladder with water. Meanwhile, a pressure monitor measures and records the pressure within your bladder. This test helps measure your bladder strength and urinary sphincter health. Urodynamic testing is expensive. It is generally done only if surgery is being considered or if treatment has not worked for you and you need to know more about the cause. It provides a more advanced way to check bladder function. Urodynamic testing may be done if other tests do not give an answer to why you have leakage of urine or your health professional suspects that you have mixed incontinence with more than one cause. The actual tests done in urodynamic testing often vary. They may include:

1.  Cystometry (cystometrography, uroflowmetry). This is a series of tests to measure bladder pressure at different levels of fullness. Cystometry tests include:

1a.  Leak point pressure (LPP), which measures weakness in the muscle that holds back urine (sphincter).

1b.  Maximum urethral closure pressure (MUCP), which measures the pressure keeping the urethra closed naturally.

2.  Postvoid residual (PVR) measurement. For the procedure, you’re asked to urinate(void) into a container that measures urine output. Then your doctor checks the amount of leftover (residual) urine in your bladder using a catheter or ultrasound. A catheter is a thin, soft tube that’s inserted into your urethra and bladder to drain any remaining urine. For an ultrasound, a wand-like device is placed over your abdomen. Using sound waves and a computer, the ultrasound creates an image of your bladder. A large amount of leftover urine in your bladder may mean that you have an obstruction in your urinary tract or a problem with your bladder nerves or muscles.

If the cause of incontinence is not identified by the above tests, more extensive tests may be needed.

The following tests are not routinely done to diagnose urinary incontinence.

Cystogram. In this X-ray of your bladder, a catheter is inserted into your urethra and bladder. Through the catheter, your doctor injects a fluid containing a special dye. As you urinate and expel this fluid, images show up on a series of X-rays. These images help reveal problems with your urinary tract.

Cystoscopy. A thin tube with a tiny lens (cystoscope) is inserted to look inside your urethra and the bladder. This way, your doctor can check for — and potentially remove — abnormalities in your urinary tract

Voiding cystourethrogram. This is an X-ray that uses an iodine-containing contrast liquid to show the shape of the lower urinary tract (bladder and urethra). This may make visible any physical abnormalities of the urinary tract that could be contributing to incontinence.

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Bladder Cancer: Symptoms and Diagnosis

General symptoms of bladder cancer include pain during urination, frequent urination, and blood in the urine. However, these symptoms could also be the result of an infection, benign tumor, bladder stone, or other issue. If you are experiencing these symptoms, see your doctor promptly to receive a diagnosis and treatment. He or she may refer you to an urologist (a doctor who specializes in urinary disease).


If your doctor thinks you may have bladder cancer, he or she will likely check your general health, perform a physical exam (checking the pelvis, rectum or vagina for tumors) and order lab tests. These tests may include:

Urine tests – The urine is checked for cancer cells, blood, or other diseases by a laboratory.

Cystoscopy – The doctor looks directly into the bladder with a thin, lighted tube inserted through the urethra. Anesthesia may be required.

Intravenous pyelogram – Dye is injected into a blood vessel and collects in the urine, allowing the bladder to be viewed via x-ray.

The doctor may perform a biopsy, where he or she removes small tissue samples with the cystoscope. Generally, a biopsy is necessary to determine whether cancer is present.

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