Painless Macroscopic Hematuria Research Articles

Diagnostic Study Of Bladder Cancer Using Urine Methylation Biomarkers Of Iraqi Patients

Background: Bladder cancer (BC) is the 4th most frequently occurring malignancy and the 9th most common cause of death worldwide in men. The invasive and metastatic form of the cancer is the main cause of death or unfavorable prognosis for BC patients. The presence of a bladder tumor is often discovered after episodes of painless macroscopic hematuria. At initial diagnosis, the disease is non-muscle-invasive in approximately 75% of patients. In recent years, detecting aberrantly methylated DNA in urine has emerged as a promising and noninvasive approach to aid BC diagnosis. Objective: To detect bladder tumors in Iraqi patients. Methods: In this cross-sectional study, sixty cases were suspected of having bladder tumors according to the opinion of the physician and some signs and symptoms, the best sign was hematuria in urine (per diagnosis). An additional 30 healthy controls with similar age and sex were recruited as control groups, with an average age of 37_85 years. from Baghdad Medical City / Ghazi al–Hariri Teaching Hospital and AlKindi Specialized Hospital during the period from September / 2023 to April / 2024. Using molecular polymerase chain reaction (high-resolution melting-PCR). Results: Out of 60 bladder inflammations, the result of hypermethylation genes ZNF154, EOMES, and POU4F2, Sensitivity were (71.7, 85, and 75) %, and Specificity (60, 33.3, and 50) % respectively with high significant differences (p < 0.01). In addition. Conclusions: Detecting DNA hypermethylation is considered a good diagnosis method for bladder tumors.

Urothelial Cancer: A Case Report of Macroscopic Hematuria

A 67 year - old male patient with painless macroscopic haematuria of 3 weeks of evolution being his only symptom. Auxiliary laboratory exams were non-conclusive. In the histopathological study of the lesion, renal pelvis with scant epithelium with atypia consistent with low-grade non-invasive urothelial carcinoma. The patient underwent a right nephroureterectomy as treatment for his condition.

Granulation tissue-type hemangioma of ureter: a highly misdiagnosed disease (a rare case report and literature review)

BackgroundUreteral granulation tissue hemangiomas are rare benign vascular lesions, and they may be clinically asymptomatic or present with massive or recurrent hematuria. Sometimes hemangiomas are difficult to distinguish from malignant ureteral tumors, and most ureteral hemangiomas are confirmed by postoperative pathological examination. This article aims to present a case of granulation tissue-type hemangioma of the ureter and briefly review the current literature on this condition.Case presentationA 30-year-old male patient presented with complaints of painless macroscopic hematuria for 2 months. Computerized tomography of the urinary system showed that the upper 1/3 of the right ureter was occupied, and then the possibility of tumor lesions was considered. The urine cytology showed occasional nuclear abnormalities and many light-stained crystals in urine. Because of suspicious radiological and cytological findings, the patient underwent the right ureteroscopy and the laparoscopic right ureteral mass resection. The postoperative pathological report showed that it was a mesenchymal tumor. The morphological and immunohistochemical staining was consistent with that of hemangioma, tending to granulation tissue hemangioma. After surgery, the patient was in a good state and recovered well at the last follow-up.ConclusionsUreteral granulation tissue hemangiomas are an easily misdiagnosed disease. Intermittent painless hematuria is an important characteristic of this disease. Therefore, we suggest that unnecessary radical surgery can be avoided when clinicians consider the possibility of benign ureteral tumors during the evaluation.

Renal cell carcinoma of horseshoe kidney

Introduction. Horseshoe kidney is the most common developmental disorder of the urinary system, which involves an anomaly of kidney fusion, and occurs in 3% of the population. Kidneys are most often connected at the lower poles by fibrous or parenchymal isthmus. Renal cell carcinoma (RCC) is the most common tumor of the horseshoe kidney. Treatment involves surgical treatment that includes heminephrectomy or partial nephrectomy with different approaches. We report a case of RCC of a horseshoe kidney, located on the lower pole and the isthmus. Case outline. A 68-year-old patient reported to the urologist due to intermittent painless macroscopic hematuria. Computed tomography urogram revealed the presence of a tumor on the right kidney, measuring 85 ? 90 ? 60 mm, with radiological characteristics of RCC, which covered the entire lower pole of the kidney towards the isthmus. Angiography finding indicated a thickened isthmus with pronounced malformation of vascular structures. The right heminephrectomy was performed with resection of the isthmus from 15 mm to the healthy tissue. The isthmus was sutured in two layers with a catgut suture. Subsequently, hilar, paracaval, and interaortocaval lymphadenectomies were performed. The pathohistological finding indicated a tumor of renal cell origin, while the resection line was free of the tumor tissue, as were the lymph nodes. Conclusion. RCC is the most common neoplasm of the horseshoe kidney. Treatment is surgical and involves open or laparoscopic heminephrectomy or partial nephrectomy with a transperitoneal or extraperitoneal approach.

Painless Visible Haematuria in Adults: An Algorithmic Approach Guiding Management.

There is consensus that visible haematuria may be a sign of serious underlying disease, including malignancy, and warrants a thorough diagnostic evaluation. This is usually undertaken by a combination of clinical examination, cystoscopic evaluation, and urinary tract imaging.A decision support tool has been developed in the form of an algorithmic flow chart as part of a suite of on-line evidence-based and consensus-based guidelines Diagnostic Imaging Pathways (DIP): www.imagingpathways.health.wa.gov.au (Online clinical decision-making tool: Dulku G. Painless Macroscopic Haematuria. Diagnostic Imaging Pathways; September 2015) to provide imaging recommendations for adult patients with unexplained, painless visible haematuria. A literature review, including reference to several international consensus-based expert guidelines, has been employed to develop this tool.The choice of first line imaging method is dependent on the risk stratification into high or low risk for the development of renal and urologic malignancies. Ultrasound is vital in the initial assessment of haematuria particularly in radiation sensitive patients, low-risk patients, and in young men <40 years. Computed tomographic urography (CTU) is a sensitive and specific method for the detection of urothelial malignancy particularly in high-risk patients. Magnetic resonance urography (MRU) provides better contrast resolution than CTU without exposure to ionising radiation or requiring intravenous (IV) contrast administration, making it more suitable for examination of paediatric and pregnant patients and patients with renal impairment. Cystoscopy remains the gold standard in the detection of lower urinary tract (bladder) urothelial tumours.Until randomised clinical trials comparing different diagnostic modalities or strategies prospectively and outcome studies are available, consensus-based practice recommendations similar to ours are nonetheless warranted to reduce the variation in haematuria management.

Renal artery pseudoaneurysm after open partial nephrectomy for renal cell carcinoma

Renal artery pseudoaneurysm is a well-described complication of open and laparoscopic partial nephrectomy. Delayed bleeding from a renal artery pseudoaneurysm is rare after open partial nephrectomy. Here, we present a 75-year-old man who, 14 days after undergoing an open right partial nephrectomy for an endophytic 4.5 cm tumor, developed painless macroscopic hematuria. Prompt computer tomography angiography imaging, followed by therapeutic angio-embolization of segmental renal artery with coils, treated the pseudoaneurysm successfully. Renal artery pseudoaneurysm can be treated rapidly, effectively, and with minimal patient morbidity via percutaneous renal artery embolization.

Diagnosis and Management of a De Novo Urothelial Carcinoma in a Kidney Allograft: A Case Report

IntroductionFollowing renal transplantation, the incidence of malignancies is 3–5 times higher than that of healthy individuals. Among other type of cancers, the risk of urological tumors is also elevated. However, only a few cases of de novo transitional cell carcinomas occurring in renal allografts have been reported. Case reportA 63-year-old tertiary transplanted male patient was urgently hospitalized for a painless macroscopic hematuria. Ultrasonography revealed pyelectasis and a hematoma in the renal pelvis. A percutaneous nephrostomy tube was inserted. An anterograde pyelography was performed later, where a filling defect was still observable in the location of the previously reported hypoechoic mass. Contrast-enhanced ultrasonography showed enhancement of the lesion. An ultrasound-guided percutaneous biopsy was performed. The histologic evaluation revealed a high-grade transitional cell carcinoma. A whole-body staging computed tomography scan did not show signs of metastatic disease. The renal allograft was surgically removed. No disease progression was observed during the 21-month follow-up period. ConclusionsPainless hematuria and asymptomatic hydronephrosis occurring after kidney transplantation should raise the possibility of urothelial carcinoma in the kidney graft. Contrast-enhanced ultrasound should be considered as a first-line diagnostic modality because it is easily accessible and does not raise concerns about nephrotoxicity or radiation burden.

A Rare Case of Urachal Adenocarcinoma: Long Term Follow Up

Introduction: Urachal adenocarcinoma is an invasive and rare bladder carcinoma that usually presents at advances stages with poor prognosis. The symptoms often include abdominal pain and hematuria. The standard treatment method is surgical excision of the tumor and sometimes, in advanced cases, chemotherapy is needed, too. Case Presentation: We present a 35-year-old male patient, who referred with acute onset of painless macroscopic hematuria. Pelvic CT scan showed a large mass on the bladder dome, extending to the umblicus. Biopsy of the mass confirmed that the pathologic diagnosis was urachal adenocarcinoma. The patient was then treated surgically with partial cystectomy approach. Conclusions: Despite microscopic involvement of pelvic lymph nodes, adjuvant therapy was not intended. There were no local recurrence or distant metastasis in long term close follow up.

Rapid development and recurrence of translocation renal cell carcinoma

Translocation renal cell carcinoma (RCC) is a rare aggressive malignancy in adults. A 40-year-old man presented with painless macroscopic haematuria. Initial investigations of renal ultrasound, CT scan, urine culture and...

Bladder cancer to patients younger than 30 years: a retrospective study and review of the literature.

The aim of this report was to study the specific characteristics of bladder cancer in patients younger than 30 years. Five patients with a mean age of 24 ± 2.83 years were included in the study. All patients had painless macroscopic hematuria as the first symptom. Three patients had pTa as a first diagnosis, one had pT1 and one pT2. All the patients had smoking as a risk factor and at least one additional possible risk factor. One patient with pTa had an aggressive course and after multiple recurrences was diagnosed with pT2 and refused to be submitted to radical cystectomy and died from the disease even though he received a multimodality treatment. The other two patients with the pTa diagnosis had no recurrence after the first TUR-BT and the patient with the pT1 diagnosis after one recurrence with a pTa histology is free of recurrence for the last 2 years. The patient diagnosed with pT2 was submitted to a radical cystectomy and an s-pouch diversion with a preservation of the genital system in order to have the ability of a future motherhood with the acceptance of course risks. Young patients with bladder cancer is a difficult group of patients and show more reluctance to comply to the necessary strict follow-up of the repeated urinary cytology examinations, cystoscopies and CT pyelographies. Herein, we report a retrospective study of five patients younger than 30 years with bladder cancer.

Transmesenteric small bowel herniation causing intestinal obstruction following laparoscopic transperitoneal nephrectomy

In the field of urology, laparoscopic nephrectomy has become the most frequently performed laparoscopic procedure. Bowel-related complications are rare and predominantly ileus related. In addition, intestinal obstruction (IO) secondary to internal herniation is rarely documented. According to our review of the literature, only a few such cases have been reported worldwide. Here, we report a 72-year-old man with painless macroscopic hematuria. He was diagnosed with left renal cell carcinoma, and he subsequently underwent laparoscopic transperitoneal left radical nephrectomy. Two days following surgery, he developed acute IO. Computed tomography of the abdomen revealed dilated small bowel loops. Laparotomy revealed small bowel herniation via a sigmoid colon mesenteric defect. After reduction of the herniated bowel loops, the defect was closed using absorbable sutures. The patient was discharged 6 days later. Internal herniation is a rare cause of IO, accounting for < 3% of cases. It occurs due to creation of a transmesocolic defect during mobilization of the left colon, facilitating small bowel migration into a potential space in the renal bed. Generally, a meticulous dissection technique is used in such cases to avoid any unnecessary mesenteric tears and repair the evident mesenteric defects observed during the intraoperative period.

Cystoscopy in children presenting with hematuria should not be overlooked

A 14-year-old girl was admitted with the complaints of intermittent painless macroscopic hematuria the ongoing for nearly two months and dysuria. Ten to 15 erythrocytes and plenty of urine leukocytes were found in the investigation. Ultrasonographic examination of the posterior wall of the bladder showed that a polypoid hypoechoic solid lesion 28 x 11 mm in size was protruding into the lumen. Cystoscopy showed a vegetating papillary tumor of 2x3 cm in size on the posterior wall of the bladder protruding into the lumen; this was then resected. Histopathological examination showed low-grade (G1) transitional cell carcinoma. In the light of this case, in children presenting with hematuria, the possibility of bladder tumors should be kept in mind; thus, retraction with the help of a cystoscope should be considered.

Myeloid leukemia in a urine specimen: A case report and review of the literature

Urinary tract cytology has a long history of utilization for the diagnosis and follow-up of tumors involving the urothelial tract. As expected, the most common tumor encountered in exfoliative urine cytology is urothelial carcinoma. While the sensitivity of urinary tract cytology for the diagnosis of low-grade urothelial carcinomas is low, its sensitivity and accuracy for high grade urothelial carcinomas is much higher. However, nonurothelial malignancies, such as hematopoietic malignancies, can also be encountered in urine specimens. Leukemic cells in urine can be diagnosed readily by cytological examination in cases where more invasive procedures are difficult to perform. Additionally, cell block sections can be utilized to determine the immunocytochemical profile of the tumor cells to confirm the diagnosis. Herein we report a case of a 75-year-old man with a past medical history of acute myeloid leukemia (AML), who presented with congested heart failure and painless macroscopic hematuria. AML relapse was diagnosed. Cytological examination of the urine using a ThinPrep® smear, cytospin preparation, and immunohistochemical stains performed on the cell block sections were examined. Findings were consistent with leukemic cells of myeloid origin in the bladder washing specimen.

BTA Stat: A Useful or an Unnecessary Urinary Marker in the Diagnosis of Primary Bladder Cancer?

Objectives: Use of urinary bladder markers in daily practice is still under debate. Our study assessed the diagnostic yield of the BTA stat test in comparison to histology, in patients presenting with hematuria. Methods: One hundred and twenty-two consecutive patients who presented with painless macroscopic hematuria and were evaluated for primary bladder cancer from November 2006 to November 2008 were retrospectively studied. Patients with a history of bladder cancer, pelvic irradiation or malignancies were excluded from the study. Patients with obvious or suspicious lesions were treated with transurethral resection of the bladder tumor and bladder biopsy was done. The test’s specificity, sensitivity, negative predictive value, positive predictive value and sensitivity in relation to tumor macroscopic features and histology were calculated. Results: Mean age was 68.1 years. Bladder cancer was diagnosed in 34 (27.8%) patients. In 30 patients (24.5%) the cause was undefined and 58 (48.3%) had benign causes of hematuria. The test was positive in 16/34 cases with bladder cancer, 12/30 with no visible cause and 12/58 of the cases with benign causes. Sensitivity was 47% and specificity 72.7%. Positive predictive value and negative predictive value were 40 and 75.6% respectively. Sensitivity was increased for high grade, nodular and invasive lesions (66, 80 and 75%, respectively). Two patients with an initial negative diagnostic work-up were later proved to have bladder cancer. The most common cause of a false positive test was cystitis. Conclusions: BTA stat, has low sensitivity for the diagnosis of bladder cancer and is not useful for the diagnosis of bladder cancer in patients with hematuria. False positive results can be minimised if patients with known or obvious benign conditions are excluded de novo from the test.

Tumor Characteristics of Urothelial Carcinoma on Multidetector Computerized Tomography Urography

We investigated the relationship between tumor characteristics of urothelial carcinoma and detectability on multidetector computerized tomography urography. We retrospectively reviewed all adult consecutive patients with hematuria who underwent multidetector computerized tomography urography during a 23-month period at our hospital. Patients with a final diagnosis of urothelial carcinoma verified by histological examination of surgical specimens were included in the study. The presence and location of urothelial carcinomas on multidetector computerized tomography urography without knowledge of final diagnosis were recorded. Tumor characteristics (location, size, histological classification and stage) were recorded based mainly on histological findings. The association between tumor characteristics and urothelial carcinoma detectability on multidetector computerized tomography urography was analyzed. A total of 70 patients who underwent multidetector computerized tomography urography had 87 verified urothelial carcinomas. Of these carcinomas 6 (6.9%) were undetectable by multidetector computerized tomography urography, including 5 ureteral and 1 bladder urothelial carcinoma. Size of detectable and nondetectable tumors on multidetector computerized tomography urography differed significantly (3.05 +/- 1.79 vs 0.65 +/- 0.99 cm, respectively, p = 0.001). Tumor location (p = 0.009), tumor size 1 cm or larger (p = 0.003) and noncarcinoma in situ tumors (p = 0.001) were significantly associated with multidetector computerized tomography urography detectability. Conversely organ confined disease had no association with multidetector computerized tomography urography detectability. Multivariate analyses showed that noncarcinoma in situ tumor was a significant predictor of multidetector computerized tomography urography detectability (p = 0.001). Multidetector computerized tomography urography is useful for detecting nearly all urothelial carcinomas in adults with hematuria. Careful assessment by multidetector computerized tomography urography is needed to detect small (less than 1 cm) or ureteral urothelial carcinomas. It remains a challenge to detect carcinoma in situ tumors by multidetector computerized tomography urography. Thus, negative results of urothelial carcinomas on multidetector computerized tomography urography do not exclude the presence of carcinoma in situ tumors.

Clinical characteristics of bladder urothelial tumors in female patients

The aim of this study was to investigate the influence of age and menopause on the clinical characteristics of bladder urothelial tumors in female patients. We retrospectively reviewed the clinical and pathological data of 215 consecutive female patients with bladder urothelial tumors who were treated at our department from January 2000 to July 2008. To investigate the relationship with age, the clinical characteristics of the patients were first classified into three groups: 50 years or younger, 51 to 69 years, and 70 years or older. Then, the women were classified into two groups: premenopausal and postmenopausal. The tumor characteristics of the two groups were analyzed to define the relationship, if any, with menopause. Furthermore, logistic regression model was constructed to discriminate variables (age and menopause). The percentage of women with bladder urothelial carcinoma increased with increasing age, and a significant difference was observed among the three age groups (P = 0.003). Painless macroscopic hematuria occurred more frequently in the group of women 50 years or older at the first presentation (P = 0.003). On the other hand, compared with premenopausal women, postmenopausal women were more frequently diagnosed with bladder urothelial carcinoma and had a higher frequency of infiltrating carcinoma (P < 0.001 and P = 0.011, respectively). Logistic regression confirmed associations between menopause and tumor characteristics, controlling for age. Our study provided evidence that the natural history of bladder urothelial tumors seemed to differ according to menopause. It was observed that the percentage of bladder urothelial carcinomas increased with menopause. Moreover, there was a tendency for postmenopausal women to present with unfavorable infiltrating carcinoma more frequently.

Inflammatory Myofibroblastic Bladder Tumor in a Patient with Von Recklinghausen's Syndrome

Myofibroblastic tumor, also known as inflammatory pseudotumor or pseudosarcoma, is a benign tumor with mesenchymal origin. Bladder location is very uncommon. We report the case of a 58-year-old man with a history of von Recklinghausen's disease who complained for painless macroscopic hematuria 5 months after suprapubic prostatectomy. The radiograph evaluation revealed a bladder tumor, and the pathologic examination following a transurethral resection showed inflammatory myofibroblastic tumor of the bladder. The patient finally underwent a radical cystectomy due to the uncertain pathogenesis of inflammatory myofibroblastic tumor as well as the rarity of cases published on bladder tumors in Von Recklinghausen's patients.

Infliximab treatment for Crohn's disease in a patient with IgA nephropathy.

We describe herein a case of IgA nephropathy in a 34-year-old woman with Crohn's disease (CD) treated with infliximab. CD first appeared at the age of 15years. An elemental diet was started for remission maintenance. Ten years later, the patient suffered from a recto-vaginal fistula and subtotal colectomy with stoma formation was performed. At the age of 33years, the patient was investigated for painless macroscopic hematuria and proteinuria. Renal biopsy revealed IgA nephropathy. Mizoribine was started but proteinuria persisted. Due to diarrhea she was admitted to our hospital, and scheduled maintenance therapy with infliximab was initiated. After the first infliximab infusion, the patient presented significant clinical improvement in both diarrhea and proteinuria with concomitant decrease of C-reactive protein to normal levels and proteinuria ~1g/day. This represents the first report of infliximab treatment in a patient with IgA nephropathy associated with CD and clarifies the importance of tumor necrosis factor-alpha (TNFα) in immunity to renal disease. Further studies are needed to draw firm conclusions for the safety of infliximab in patients with IgA nephropathy.

Comparison of CT virtual cystoscopy of the contrast material-filled bladder with conventional cystoscopy in the diagnosis of bladder tumours

To investigate the value of virtual cystoscopy using contrast material to fill the bladder during routine abdominopelvic computed tomography (CT) examinations for the detection of bladder tumours. Thirty-three consecutive patients (25 men and eight women; are range 51-82 years; mean age+/-SD, 65+/-7 years) who had painless macroscopic haematuria and were suspected to have bladder neoplasms were prospectively evaluated with virtual cystoscopy. After intravenous injection of contrast medium, the contrast material-filled bladders were examined with single-detector helical CT with 2-mm section thicknesses. Source CT data were transferred to a workstation for interactive navigation using surface rendering. All the patients also underwent conventional cystoscopy. The results of virtual cystoscopy were compared with the findings from the conventional cystoscopy. Seventy-one of 78 bladder tumours detected with conventional cystoscopy in 28 patients were also shown on virtual images. The bladders of five patients appeared normal on both conventional cystoscopy and virtual cystoscopy. On virtual cystoscopy, seven of the 12 lesions that were < or =5 mm in diameter could be identified. The following statistical values for the identification of bladder lesions using virtual cystoscopy were calculated: sensitivity 94%, specificity 90%, positive predictive value 87%, negative predictive value 93%, and accuracy 93%. CT virtual cystoscopy is a noninvasive technique that can be used successfully for detection of bladder tumours >5 mm in selected cases during daily routine abdominopelvic work.

Pyelovenous fistula: a rare cause of hematuria

A 72-year-old female who was admitted to our urology clinic with painless intermittent macroscopic hematuria existing for 3 months with no other voiding symptom was diagnosed with left pyelovenous fistula. Although a rare condition, pyelovenous fistula should be kept in mind when the cause of macroscopic hematuria cannot be diagnosed with routine radiological examinations, and retrograde pyelography should be the method of choice for the diagnosis in this rare condition.