If a bladder carcinoma is suspected, different examinations are usually necessary. In the following, we would like to explain the background and the meaning of the individual methods, so that you can get a good picture of the available diagnostic options.
THE URINE ANALYSIS
For the examination of the so called urine sediment, the urine is processed so that it can be examined microscopically. Urine cylinders, epithelial cells, leucocytes, erythrocytes, bacteria and crystals can be detected in the urine sediment. The urinary sediment is especially helpful in the diagnosis of bladder cancer. Microhematuria can be detected and further assessed accordingly.
The benefits of urine test strips are largely limited to the detection of infections and bleeding in the urogenital area. As a further diagnostic a urine sediment is recommended.
Microhematuria refers to the addition of blood in the urine, which is detectable only under the microscope or in the so-called Urinstix. The American Association of Urology (AUA) Guideline 2012 recommends that urological diagnostics should be performed in patients with recurrent, asymptomatic microhematuria without benign cause.
In urine cytology, urine is examined for the presence of pathological cells. The urine cytology has a high specificity (accuracy) especially in the diagnosis of particularly aggressive high grade tumors (90-100%).
If there is a suspicion of a tumor in the urinary bladder, the so-called cystoscopy usually takes place initially. This is performed in our house with a particularly gentle flexible instrument, as this can ideally adapt to the special anatomical conditions of the urethra and thus is particularly comfortable for the patient. Here, the suspicion of the presence of a tumor can be eliminated or approved.
In case of an abnormal finding in the bladder, in a second procedure under anesthesia appropriate biopsies or TUR-B (link) are performed, which then provide information on whether it is a malignant tumor and if so, how deep the tumor is grown in the bladder wall.
If suspicion of bladder cancer is confirmed by this sample, further investigation is needed to determine the spread of the disease.
PHOTODYNAMIC DIAGNOSIS (PDD)
The so-called fluorescence endoscopy allows the TUR-B (link) to achieve a special "staining" of bladder tumoral cells in the bladder. For this purpose, the fluorescent dye is introduced into the bladder via a thin catheter before the bladder cystoscopy and should then remain in the bladder for at least one hour.
The dye is now increasingly absorbed by tumor cells and then leads to an improved representation of the tumor area during the removal of the tumor from the bladder. Thus, even the smallest tumors as well as otherwise difficult-to-detect aggressive tumors (such as the so-called CIS) can be diagnosed and treated immediately without any delay.
Another advantage of this method is also the possibility of a complete removal of tumors that are at the borderline and surrounding of an initially well visible tumor.
This procedure gives you the greatest possible assurance of complete removal of a non-muscle invasive bladder tumor. Various international and national studies have shown that with the help of this method, more tumors can be found and thus the probability of a recurrence of the tumor can be reduced. https://uroweb.org/
Especially tumors which due to their flat growth (carcinoma in situ) or their small size are easily overlooked in the context of conventional bladder cystoscopy can be found in this way.
Fluorescence endoscopy (left) versus white light endoscopy (right)
The circumscribed red fluorescence marks an aggressive carcinoma in situ, which is very difficult or even impossible to detect in conventional white-light endoscopy.