Uro 2 Interstitial Cystitis/Bladder cancer – Flashcards
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interstitial cystitis -etiology
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-unknown -may be some theories
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theories of how IC can happnen
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-autoimmune response following bladder infection -bacterium may be present in bladder but not detected through routine urine test -hereditary
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interstitial cystitis -associated with what
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-allergies -IBS -IBD
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interstitial cystitis -m and f?
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both but mainly women
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interstittial cytisis -average onset
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40yo
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interstitial cystitis symptoms
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-pain with bladder filling --relived with urination -urgency -frequency--up to 60 times a day -nocturia -pain during sexual intercourse
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interstitial cystitis -womens sysmptoms get worse with what?
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menopause
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Interstitial cystitis -how is it diagnosed
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-pain with full bladder or urinary urgency -submucosal petechiae or ulcer on cytstoscopic exam -diagnosis of exclusion
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what kind of ulcer in the bladder might IC pts have?
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Hunners ulcers
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IC -what might the bladder wall look like?
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-irritated -scarred -stiff -glomerulations (pin point bleeding) -thinning of protective bladder lining
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IC -differential diagnosis
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-radiation cystitis -chemical cystitis -eosinophilic cystitis -tuberculous cystitis -genital herpes -bacterial vaginitis -urethral diverticulum -uretheral carcinoma -bladder carcinoma (make sure to eval for these because they can be pretty common even if youre thinking IC)
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What lab tests should we do
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-UA and Culture -Urinary cytology
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UA and culture why
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to exclude infections
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urinary cytoogy why
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to exclude bladder cancer
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what diagnostic procedures should we do??
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-urodynamic testing -bladder biospy -hydrodistention
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urodynamic testing can tell us what info
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-sensation -compliance ---can RO detrusor instabilitiy
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bladder biospry for what
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-assess inflammation -assess cancer
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hydrsodistention procedure
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-fluid into the bladder via cytoscope -with GA or spinal anesthesia -high pressure is reached
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hydrodistention -once water is released what happens?
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- glomerulations (submucosal hemorrhage) --small bleeding points on the bladders surface +++ dx of IC
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bladder cancer early signs and symptoms
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-most pt are asymptomatic in the early stages
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how much pressure is reached in the bladder with hydrodistension
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80-100cm h2o
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is there a cure for IC
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no --but can achieve symptomatic relief
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IC treatment options
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-diet -supportive -procedures -medications
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IC -diet tx
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-avoid drinks or foods that exacerbate symptoms --tomatoes --caffeiene
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IC -supportive tx
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-analgesia -smoking cessation
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IC -tx procedues
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-hydrodistention -transcutaneous electric nerve stimulation (TENS) -acupuncture
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what is hyrdodistention used for
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diagnostic and tx.. TX: 30% of pt get symptomatic relief
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hydrodistention -how often used for tx
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-not that often -pretty invasive and not that high of success rates -only temporary relief of symptoms
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IC meds
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-amitriptyline (TCA) -nifedipine (Calcium channel blocker) -pentosan polysulfate sodium (elmiron) --meds that can be given intravesicalarly
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amitriptyline -how often is it used -how does it hep
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-used as first line medical therapy -blocks pain -calms bladder spasms -decreases inflammation
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nifedipine benefits
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...she doesn't say
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pentosan polysulfate sodium benefits
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-sulfated polysaccharide --helps restore integrity to epithelium of the bladder
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what intravescial drugs can be ive
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-dimethyl sulfoxide or heparin -bascillus calmette-guerin
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surgery tx
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-cystourethrectomy with urinary diversion in extreme cases
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when do we refer pt with IC
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-persistent and bothersome symptoms and cannt id cause
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Bladder cancer -how common -m:f
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2nd most common urologic cancer -m:f 3:1
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bladder cancer risk factors
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-cig smoking (>50%) -exposure to industrial dyes and solvents** -age, over 70 2-3x more likely -white aa hispanic -chronic bladder inflammation (Recurrent UTI, urinary stones) -consumption of aristolochia fangchi (used in weight loss) -exposure to beam readiation
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what is the most common types of bladder cancers
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-urothelial cell carcinomas 90% -squamous cell 7% -adenocarcionoms 2%
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what stage do we most commonly find bladder cancer?
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superficial stag
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bladder cancer -MC s/sx
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painless hematuria 85-90% of all pt
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other bladder cancer symptoms
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-irritative voiding symptoms ---only in a small percentage though
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how can we detect bladder cancer masses
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-bimanual exam w/large volume
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what are some signs of metastatic bladder cancer?
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-lymphedema w/LE -palpable pelivic lymph nodes -hepato megaly
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when do we most commonly find bladder cancer -prognosis
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at the early stages -80% survival rate if at metastic disease then long term survival is rare
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lymph node metastases would likely show
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-progression which is uncommon in pt that have recieved tx
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bladder cancer -what is essential for dx
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-irritative voiding symptoms -gross or micro hematuria -+urine cyto in most pt -filling defect within bladder noted on imaging
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lab tests for bladder cancer
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-UA --hematuria --sometimes pyuria -azotemia: high BUN -anemia
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bladder cancer -imaging study options
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-US -CT -MRI
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what would the imaging studies for bladder cancer show?
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defects w/in bladder
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diagnostic procedures bladder cancer
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-cytology -cystourethroscopy and biopsy -transurethral resection of bladder tumor (TURBT)
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TURBT what does it tell us
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-proper staging of cancer -can be used to control superficial cancers
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superficial bladder cancer tx
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-TURBT -selective intravescial chemo
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high grade bladder cancer tx
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-TURBT -intravesical chemo
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more invasive but still localized bladder cancer tx
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-radical cystectomy -or combo of chemo and selective surg
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muscle invasive bladder cancer tx-
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-neoadjuvant systemic chemo then -radical cystectomy
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what does intravescial chemo intail?
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chem for 6-12 weeks (cisplatin combo) -bacillus calmette guerin -thiotepa -mitomycin -doxorubicin
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intravesical chemo SE
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-irritative voiding sympt -hemorrhagic cystitis
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when is a partial cystectomy indicated?
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in pt with bladder cancer in the diverticulum
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how long is radiotherapy given
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6-8 weeks
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radiotherapy SE
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-bladder, bowel or rectal complications in 10-15% pt -recurrence common
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what other therapies can be used for bladder cancer
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-interferons -keyhole limpet hemocyanin (KLH) -photodynamic thearpy (PDT)
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bladder cancer recurrence rate
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up to 80% recurrences are usually more of a bitch to deal with
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when to refer?
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all bladder cancer pt should be refered to radiologist
