👒 Bladder CA

Haematuria History # True Haematuria or Not # Exact Color: Dark tea color (OJ) Exclude Pseudohaematuria: Itching & steatorrhoea Factitious Haematuria: Munchausen’s syndrome, narcotic seeking behavior Past History # Bleeding diathesis & other bleeding manifestations Relation of Gross Haematuria to Urinary Stream # Initial (urethra distal to urogenital diaphragm) Total (bladder proper or upper urinary tract) Terminal (trigone/ bladder neck of prostatic urethra) Painless or Painful # Painless: Malignant but can cause pain due to clot colics Painful: Urinary tract infection or calculus, papillary necrosis, passage of clots, obstruction, loin-pain haematuria syndrome, glomerulonephritis Clots # Indicate non-glomerular bleeding Large, thick, irregular clots - bladder Small, linear clots - upper tract Passage of tissues Associated Symptoms # LUTS Fever, chills & rigors with loin pain or suprapubic pain Any loin pain with self-felt loin lumps (Classic triad of RCC 10% - haematuria+loin pain+loin mass) Tissue passage Vaginal or penile discharge, sexual activity Presence of urinary catheter Relation to menstruation (endometriosis) Anemic symptoms GU History # History of BPH, stone disease (Hx of GU cancers) Hx of instrumentation Hx of pelvic irradiation Aetiology for Malignancies # Smoking Occupational exposure to dye stuffs and rubber compounds Hx of travel to middle east countries (Schistosoma haematobium) Family history malignancy (bleeding diathesis + renal disease) Metastatic Features # Fitness for Sx PMHx- # PSHx- # Drug Hx- # Antiplatelets or anticoagulants, cyclophosphamide SHx- # Job(risk factors)/family Smoking/alcohol Disability/concerns Examination # General # Anemia/plethora Facial oedema/ periorbital oedema, rather than ankle edema suggest renal pathology Unilateral or bilateral ankle edema- think of Iliac vein compression in unilateral edema Bone tenderness Muscle weakness Malignant cachexia- anaemia asthenia anorexia Ask for BP Abdomen # Palpable suprapubic mass- distended bladder, anterior wall bladder tumor Ballotable renal mass Hepatomegaly Ascites DRE & genital Ex (non-reducing left varicocele) Summary # This 60 yrs old ASA 2, MET score >4, male patient with episodic visible haematuria over 3 months associated with occasional clots & passage of tissues. ...