There are many causes of hematuria, such as inflammation of the urinary tract, stones, trauma, prostate enlargement and cancer. However, hematuria caused by cancer often does not have any accompanying symptoms. Experts point out that except for red urine with blood clots in the early stage of bladder cancer, patients have no other discomfort. The hematuria caused by bladder cancer is self-limiting, and the bleeding will stop on its own within a few days. Many patients mistakenly think that it is “heat” or “inflammation”, so they take medicine by themselves and treat the disappearance of hematuria as getting better, thus delaying the diagnosis and treatment of tumor.
Symptoms: 70% of patients have painless hematuria for the first time
Bladder cancer is the most common urological tumor in middle-aged and elderly people, and the incidence rate increases year by year after 60 years old, and the peak age of incidence is about 68 years old, and the number of male bladder cancer patients is about three times that of female.
The specific causes of bladder tumors are unknown, and the risk factors for the development are generally considered to include.
1, long-term exposure to carcinogenic substances, such as dyes, textiles, leather, rubber, plastics, paints, printing, etc;
2, smoking;
3.Chronic bladder infection and long-term stimulation by foreign bodies;
4, long-term heavy use of analgesics finasteride, abnormal metabolism of endogenous tryptophan, etc.
Domestic and foreign epidemiological survey statistics show that the probability of bladder cancer for patients with sarcoid hematuria is 13%-34.5%, while 70% of bladder cancer patients have painless sarcoid hematuria as the first symptom, and only about 10% of patients have symptoms of urinary frequency, urinary urgency and urinary pain at the beginning. Therefore, doctors suggest: when carnal hematuria occurs, it is important to find a urologist for a thorough examination and clear diagnosis.
Treatment: laparoscopic bladder removal is less invasive
Different bladder cancers require different surgeries. For superficial bladder cancer, since it grows on the bladder wall like watercress with shallow roots and usually does not invade the bladder muscle, cystectomy is usually not needed and the tumor can be removed by inserting cystoscope through urethra and using electric knife or laser. Another type of invasive bladder cancer, because of its deeper roots like a tree, often invades the muscle layer or even the whole bladder wall, and is prone to local and systemic metastases, often requiring removal of the entire bladder, as well as removal of pelvic lymph nodes that may have metastases.
In order to reduce trauma, laparoscopic radical resection of bladder cancer has been adopted in recent years, which requires only a few small holes in the abdominal wall and then removal of the bladder under laparoscopy, with less surgical bleeding, less trauma and faster postoperative recovery, said Jian Huang.
Examination: Ultrasound of kidney and bladder can be screened
Professor Huang Jian, director of urology department of Sun Yat-sen Memorial Hospital of Sun Yat-sen University, pointed out that there are two types of bladder cancer examinations, non-invasive and invasive. Non-invasive examinations include urinalysis, kidney and bladder ultrasound, pelvic CT or MRI examination, etc.
Kidney and bladder ultrasound can be the main screening test for bladder cancer because of non-invasive and low price factors. Invasive examinations mainly include plain cystoscopy and fluorescence cystoscopy. After ultrasound examinations reveal a mass in the bladder, cystoscopy can be inserted through the urethra to visualize the condition of the mass in the bladder, and some tumor tissues can be clamped for pathological examination to confirm the diagnosis of bladder cancer and its malignant degree.
In order to increase the accuracy of cystoscopy, fluorescent staining is used followed by cystoscopy, which is called fluorescent cystoscopy. It improves the early diagnosis rate of bladder cancer and allows the tumor to be removed directly under fluoroscopy, reducing the postoperative recurrence rate.
Postoperative: Tumors are prone to recurrence after bladder preservation surgery
According to Jian Huang, about 50% of various surgical treatments to preserve the bladder may have tumor recurrence within two years, and often not in the original site, which is actually a newborn tumor. About 10% to 15% of recurrent tumors have a tendency to increase in malignancy, and it is still possible to cure recurrent tumors with timely treatment. Therefore, any postoperative patient with preserved bladder should be closely followed up and cystoscopy should be done every 3 months, and for those who have no recurrence for 2 years, it should be done every 6 months.
There is no effective preventive measure for bladder cancer, but occupational personnel who are closely exposed to carcinogenic substances should strengthen labor protection and smokers should quit early to possibly prevent or reduce the occurrence of tumors. Bladder instillation of chemotherapeutic drugs and BCG treatment for post-surgical patients with preserved bladder can prevent or delay the recurrence of tumor.
Tips:
Can I still urinate on my own after having my bladder removed?
There are three types of urination after cystectomy: transabdominal stoma, transanal urination and transurethral urination. The disadvantage of this method is that the number of bowel movements increases and some patients have incomplete urine control, which makes it easy for urinary tract infections to occur; transurethral urination is to use the patient’s own intestines to make a new bladder and connect it to the urethra. This is called in situ neobladder surgery.
This approach is closest to normal physiology and has a higher quality of life after surgery. However, not all patients can use this method. It requires that the tumor is not growing in the urethra, that the tumor is completely removed, that the patient has no urethral strictures, and that the patient has good urinary control before surgery.