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Diagnosing & Monitoring Bladder Cancer

Banner Image: Dr. Neal Shore, a member of the BCAN Board of Directors, speaks with a patient.

Radiological Test:  CT Urogram

The CT urogram is a radiological test to explore possible reasons for blood in the urine or other symptoms. This specialized scan uses intravenous (IV) contrast (a substance used to enhance the visibility of internal structures in X-ray based imaging) to examine the upper urinary tract (kidneys and ureters) in detail.  This test is particularly good at finding tumors of the kidney, renal pelvis, and ureter, as well as other urologic pathology. This may identify kidney stones and hydronephrosis (swelling of the kidney that is often due to downstream blockage).  In addition, the entire abdomen and pelvis is also imaged.  This allows a radiologist to identify other abnormalities in these parts of the body.

The use of IV contrast requires normal kidney function prior to performing the test.  Blood work will be ordered by your healthcare provider before you can receive the contrast required for a CT urogram.  If the contrast cannot be given, your healthcare provider may decide to perform a CT scan without contrast or other imaging study.  A urologist may decide to perform a small procedure called “cystoscopy (see below) and retrograde pyelograms.” This involves placing a camera into the bladder and performing x-rays while injecting dye into the ureters.  This study can be used in the setting of kidney dysfunction. Like a CT urogram, it can help to identify abnormalities of the ureter and renal pelvis.

While some bladder tumors may be found on a CT urogram or other imaging test, others will not.  A urologist will often recommend a cystoscopy to evaluate the lower urinary tract (bladder/urethra) for a source of blood in the urine or to workup other urologic symptoms.

Cystoscopy: The Gold Standard

Although radiological tests provide important information about the kidneys and the ureters, cystoscopy is still the best method of evaluating the bladder and the urethra. The cystoscope, a long thin camera, is inserted through the urethra into the bladder.

Today, using flexible cystoscopes, most of these diagnostic procedures are performed in a urologist’s clinic with little or no discomfort.  During the cystoscopy, the urologist will look through the cystoscope and make a note of anything in the bladder that may be abnormal.  If a tumor or other abnormality is identified, the urologist will likely schedule you for a cystoscopy under anesthesia with bladder biopsy or “transurethral resection of bladder tumor (TURBT).”

Some urologist may have the ability to perform small bladder biopsies in the office.  The tissue sample, or biopsy, is then sent to the pathologist for examination. A sample of the urine from the bladder is sent for analysis of the cells (called cytology) to determine if the urine contains any cancer cells. The biopsy specimen and the urine sample will help the urologist make recommendations about your future care.

Patients will go home after the cystoscopy if it is done in the doctor’s office. There may be some bleeding and irritating bladder symptoms following the cystoscopy for a day or two. If the symptoms do not improve within 3-5 days, notify your urologist.  Seeing blood in the urine can be very troubling, even small amounts of blood can change the color of the urine dramatically. This should resolve on its own. Make sure to stay hydrated to help keep your urine diluted.