Comparative evaluation of nonesterified and total urinary cholesterol in papilloma and carcinoma of the bladder

Abstract

Urinary excretion of nonesterified (NEC) and total cholesterol (TC) has been determined in 137 healthy individuals with a range (2 SD) of 0.26-2.2 mg/24 hours NEC and 0.3-3.0 mg/24 hours TC. 264 patients with various internal diseases revealed normal values of NEC and TC; neoplasias, diseases of the kidney and prostatic adenoma with residual urine had been excluded with reasonable certainty. There was no correlation between urinary cholesterol excretion and cholesterol plasma levels. In papilloma of the bladder (n = 16) NEC hyperexcretion was present in 56%; elevated levels of TC were determined in 68%. In carcinoma of the bladder, T1N0M0-T2N0M0 (n = 28), hyperexcretion of NEC occurred in 50% and of TC in 64%. In advanced clinical stages of the disease, T3N0M0-T4N4M1d (n = 21), elevated values of NEC were detected in 76% and of TC in 90%. Since all macroscopically blood contaminated urinary samples had been excluded, a determination of total urinary cholesterol excretion may be valuable in the diagnosis of papilloma or carcinoma of the bladder in the absence of macrohematuria. Occult blood in urine was present in 33 of the 65 patients with papilloma or carcinoma of the bladder, which was associated in 26 cases with elevated urinary total cholesterol. 32 patients revealed a negative test for occult blood in urine. In 22 of these, hyperexcretion of urinary total cholesterol was observed, indicating diagnostic sensitivity of this parameter for papilloma and carcinoma of the bladder even in the absence of microhematuria. However, one has to regard that elevated urinary cholesterol levels could also occur in other carcinomas of the urogenital system, prostatic adenoma with residual urine and kidney diseases.