I am doctor Saurabh Mishra. I am a senior consultant in the department of urology. Today I am going to discuss hematuria. Hematuria means blood in the urine. It's a common symptom and it can happen in young, middle-aged and elderly; all three categories of the patients can face these symptoms. Now, the haematuria is of two types: one is painful hematuria and the other one is the painless hematuria. As the name suggests, painful hematuria means the blood in urine is associated with painful urination also. This usually occurs in young patient or middle-aged patient and the most common reason for this is urinary tract infection. Painless hematuria usually occurs in the elderly males and the majority of the reason is malignancies. So, today we will be restricting ourselves to the painless hematuria. Painless hematuria in an elderly patient the commonest reason is urinary bladder cancer or urinary bladder tumour. This has been taken as the most common cause of continuous painless gross hematuria in more than 60 years age.
This is the second commonest urological cancer found in the males. So, males are more commonly involved compared with the female for the urinary bladder cancer and the ratio is usually 2:1 means every two males one female is involved. The common presentation of urinary bladder cancer as I told you is the hematuria. Most of the times the second most common cancer which can cause hematuria is the prostate cancer will be focusing more on CA bladder today not CA prostate. CA prostate will discuss in any other time so coming back to the urinary bladder cancer. The commonest age presentation I told is more than 60 years. It is the most common cause of hematuria as I told earlier is the commonest reason for hematuria in males. How we diagnose bladder cancer? The most common and the best modality to detect urinary bladder cancer is the endoscopy of the urinary bladder which is called cystoscopy.
The benefit of cystoscopy is that you can clearly visualise the tumour, you can take biopsy of the tumour, along with that if it is a superficial bladder cancer limited to one part of the urinary bladder you can completely remove the urinary bladder tumour. Urinary bladder tumour are divided in two categories: one is the superficial bladder tumour and the deep bladder tumours. The superficial and deep bladder tumours are divided on the basis of involvement of the cancer of the particular depth of the urinary bladder wall. So, as the name suggests superficial bladder cancer is the early-stage cancers and they can be very well treated by endoscopic pressure called TURBT means transurethral resection of the bladder tumour. It is similar to the TURP which is a common procedure done for prostate. So, if you see 70% of the patients are in the superficial category. So, 70% of the patient they very well get it treated by the endoscopic procedure without any cut or incision outside the body.
The rest 30% of the patients have deep bladder tumour and they need an extensive surgery in form of complete removal of the bladder, prostate, surrounding lymph nodes etc and the urinary bladder has to be urine has to be diverted and the commonest diversion is a hole is made in the abdomen at one quadrant and a part of the intestine is made in form of urinary bladder and one end is opened outside the abdominal wall and both the ureter means both the kidney are opened in one part of the newly made urinary bladder by the intestine. So, coming back to the superficial bladder cancer, the recurrence level in the superficial bladder cancer is very common but the progression of the cancer is not that common.
So, the possibility of recurrence is more than 70%. So, there has to be committed follow-up of these patients. So, there is a follow-up strategy made for CA bladder. This says that all the patient has to be followed up with endoscopy or the urethroscopy of the urinary bladder every three months for a period of one year, every 6 months after 1 year following the 2 years. And after that N1 cystourethroscopy is performed. Now, anytime in this time period if you come across recurrence, you remove it completely and it is again started as a fresh that means one every 3 monthly, 1 year every 6 monthly for another 2 years and N1 later on. So, anytime if there is progression then accordingly you treat the patients like I have already discussed in the deep invasive tumours and if it is just a recurrence you keep on treating like I have already told.