Bladder cancer is a malignant growth in the urinary bladder . Most commonly it is also called as Transitional Cell Cancer or Urothelial Cancer. Bladder cancer can be of two types: Non- Invasive or Superficial type and Invasive type. The treatment of the bladder cancer depends on the stage of the cancer, grade of the cancer and the general condition of the patient.
Patient education
Symptoms of bladder cancer may include:
- Hematuria or presence of blood in the urine. This is usually painless and causes the urine to appear bright red coloured.
- Irritative Storage Lower urinary tract symptoms (LUTS)
- Frequent urination
- Urgency of urine
- Increased frequency of urine at night or Nocturia
The tests and procedure done to diagnose bladder cancer may include:
- Ultrasound abdomen: This is a simple and non invasive test which can determine the presence of a mass in the bladder.
- Urine cytology: A sample of your urine is examined under the microscope for the presence of cancer cells.
- Diagnostic Cystoscopy: A small, narrow telescope is inserted through your urethra which allows the octr to see the inside of your bladder, to identify the location of the tumor.
- Biopsy: During cystoscopy, a small piece o tissue is obtained from the tumour mass for testing. This procedure is also called Transurethral Resection of bladder (TURBT). TURBT is sometimes also curative in superficial bladder cancer.
- CECT Abdomen and Pelvis: This imaging test allows the doctor to know the extent of the disease. It also gives information regarding the kidney and the ureters and whether the cancer has spread to the lymph nodes.
- Metastatic work up to know if the cancer has spread to other parts of your body.
Approximately 70% of the bladder cancers are non invasive type. The treatment of the non- invasive bladder cancer is "transurethral resection of the bladder tumour" or TURBT
When the tumour invades the deeper bladder wall it is called Invasive Bladder Cancer. The deeper the cancer penetrates the bladder wall, more is the probability that it may spread to the draining lymph nodes or spread to the other parts of the body. All this information is importtant for the doctor to decide the treatment approach.
The following are the treatment options for the bladder cancer which has not spread to the other parts of the body.
- Transurethral resection of bladder tumor (TURBT)
TURBT is a Endo Urorology procedure where in the doctor removes any abnormal appearing area in the urinary bladder using a Cystoscope. This is the primary treatment option for Non Invasive Bladder cancer. After several weeks the doctor will again have a look inside your bladder using a Cystoscope. If there is no evidence of cancer, you will be followed up closely. This is sometimes followed by additional therapy, which reduces the chances of the cancer recurring - Radical Cystectomy:
Approximately, 30 percent of the bladder cancers are muscle-invasive and they warrant surgical removal of the entire bladder, the nearby organs and the associated lymph nodes. Radical cystectomy also requires creation of an alternative way for excretion of urine called as Ileal Conduit. Wherein the urine is diverted through a segment of bowel to the skin's surface, where an opening (called a stoma) is created. A bag is attached to the stoma to collect the urine. The outcome following Radical cystectomy will depend on the stage and extent of your cancer. This procedure is combined with preoperative or postoperative chemotherapy depending upon the individual situation - Surgical complications —
The most common complications include infection (especially wound infection or urinary tract infection) Following surgery, it is very important to follow all your doctors' instructions about rest and recovery after surgery. In men, Radical Cystectomy can damage the nerves responsible for achieving and maintaining an erection which may require medications - Partial Cystectomy:
Partial cystectomy is partial removal of the bladder wall along with the tumor and leaving behind the normal healthy bladder. However, this is a treatment option in only less than 5 percent of the patients where in the tuour is very small and located on the dome of the bladder or within a bladder diverticulum. - Chemotherapy :
The muscle invasive bladder require Chemotherapy in addition to Surgery. Chemotherapy refer to the use of intraveonus medications to slow or stop the growth of cancer cells. In some patients, the chemotherapy may be given before surgery. In case chemotherapy is not given before surgery, then it may be given after surgery. The decision of the timing of chemotherapy depends on multiple factors which will be discussed by the doctor. The most common side effects of chemotherapy include fatigue, nausea, vomiting ,pricking sensation over the hand and feet, hair loss. Most of these side effects are temporary, treatable, and resolve after chemotherapy is completed.
Patients in whom the bladder cancer has spread to the other parts of the body, Chemotherapy is usually the first treatment. Paitnets in whom chemotherapy doesnot work or is not tolerated, Immunotherapy (medicine that modulate the immune system to attack cancer cells) can be tried.
Benign prostatic hyperplasia is a condition in which the prostate gland increases in size leading to the blockage in the flow of urine. BPH occurs in approximately 8 percent of men under the age of 40 years. The occurrence of BPH increases with increasing age. In men over age 80, more than 80 percent have BPH.
The most common symptoms of BPH include the need to urinate frequently especially during the night, a poor stream of urine, and dribbling of urine. These symptoms are called lower urinary tract symptoms (LUTS).
In the BPH is left untreated, it can cause urinary retention, which means the man is unable to pass urine leading to over-distension of bladder. In this situation emergency catherisation (passing of urine tube) is required to empty the bladder.
Assessment of Symptoms of BPH using International Prostate Symptom Score (I-PSS):
| In the past month | Not at all | Less than 1 in 5 times | Less than half the time | About half the time | More than Half the time | Almost Always | Your Score |
|---|---|---|---|---|---|---|---|
| 1. Incomplete Emptying How often have you had a sensation of not emptying your bladder completely after you finished urinating? | |||||||
| 2. Frequency How often have you had to urinate again less than 2 hours after you finished urinating? | |||||||
| 3. Intermittency How often have you found you stopped and started again several times when you urinated? | |||||||
| 4. Urgency How often have you found it difficult to postpone urination? | |||||||
| 5. Weak Stream How often have you had a weak urinary stream? | |||||||
| 6. Straining How often have you had to push or strain to begin urination? | |||||||
| 7. Sleeping How many times did you most typically get up to urinate from the time you went to bed at night until the time you got up in the morning? | |||||||
| Total IPSS score |
Score : 1-7 Mild 8-19 Moderate 20-35 Severe
| 8. Quality of Life | Delighted | Pleased | Mixed | Mostly dissatisfied | Unhappy | Terrible | |
|---|---|---|---|---|---|---|---|
| If you were to spend the rest of your life with your urinary condition the way it is now, how would you feel about that? | 0 | 1 | 2 | 3 | 4 | 5 | 6 |
- • Digital Rectal Examination: The doctor will perform a rectal examination to help determine the size of the prostate and also assess the presence of prostate cancer.
- • Urine Test: To see if there is any urine infection
- • Blood Test: Prostate Specific Antigen (PSA) may be found elevated in prostate cancer.
- • Ultrasound abdomen and pelvis: To determine the size of the prostate and also the post void residue of urine.
Treatments for BPH can help to reduce urinary symptoms. Treatment options include medicines and surgery (TURP)
Kidney stones are common, affecting approximately 1 in 5 males and 1 in 10 females in the lifetime. The kidney stones can be made up of calcium oxalate, triple phosphate or uric acid.
A kidney stone can be formed due to multiple causes. Certain diseases, dietary habits or medicines can lead to increased risk of formation of kidney stones. Once you get a kidney stone , you have an increased chances of formation of kiney stones repeatedly. A kidney stone can formed due to increase in the levels of calcium, oxalate, cystine, or uric acid in the urine. These substances form tiny crystals, which get deposited in the kidney and gradually increase in size, to form a kidney stone.
The stone will try to pass out of the body through the urine. However, when a stone gets stuck, it will cause severe pain and block the flow of urine. Large stones do not pass on their own and require a surgery to remove them.
A kidney stone may sometimes remain in the kidney for a long time without causing any symptoms. However, when the stone gets stuck in the urinary tract, it leads to severe symptoms
Pain — Pain due to kidney stone may range from mild discomfort to severe intense pain. A very severe pain in the flanks requires treatment in the hospital. Typically, the pain fluctuates in severity but does not go away completely without treatment.
Blood in the urine — A kidney stone may lead to blood in the urine (hematuria. If you notice blood in your urine, you should immediately consult a Urologist.
Gravel — Sometimes patients may pass "gravel" or "sand," in the urine
Other symptoms — Other kidney stone symptoms may include nausea or vomiting, pain with urination, and an urgent need to urinate.
Kidney stones can be diagnosed based upon your symptoms, a physical examination, and imaging tests.
Ultrasound — An ultrasound can also be done to detect kidney stones, although small stones or stones in the ureters may be identified on an ultrasound. Ultrasound is the preferred diagnostic procedure for people who should avoid radiation exposure, including pregnant women and children.
Computed tomography (CT) scan — A non-contrast CT KUB is often recommended if kidney stones are suspected because it is the best way to determine the presence of stones. Plain X-rays cannot reliably detect kidney stones in all situations.
Treatment of a kidney stone depends upon the size and location of the stone. If the stone is small, it is likely to passed out from the urine.
However, if the pain is severe, you will need to be treated with stronger pain medications and intravenous (IV) fluids.
If you have a fever, you will also need treatment in the hospital as soon as possible, as this could indicate a potentially serious infection.
Small kidney stones can be treated at home by medication to help the stone pass more quickly under the guidance of your Urologist
However, stones larger than 9 or 10 millimeters rarely pass on their own and generally require a procedure to break up or remove the stone.
Ureteroscopy (URS) — Ureteroscopy is a procedure in which the Urosurgeon passes a thin telescope through the urethra and bladder, into the ureter and kidney The stone is either removed or to broken it into smaller pieces that can pass more easily.
Percutaneous nephrolithotomy (PCNL) — This is a minimally invasive surgery in which a nephroscope is passed through the skin of the back and into the kidney to remove the stone. Very large or complex stones, or large stones need to be removed this way.
Shock wave lithotripsy (SWL) — This is a non invasive procedure that involves directing high-energy shock waves towards the stone. This energy causes the stone to break into fragments that can be more easily passed in the urine. Shock wave lithotripsy is not effective for treating large or hard stones.
The following precautionary measures may be recommended to lower your risk of having stone in the future:
- ● Drinking more fluids can help lower your risk of kidney stones. The goal is to increase the amount of urine that flows through your kidneys and also to lower the concentrations of substances that promote stone formation. Beverages (such as soda and sports drinks) increase the risk of kidney stones and hence should be avoided.
- ● Depending upon the nature of the stone preventive medication may be advised reduce the risk of future stones.