Diseases of the URINARY BLADDER are diagnosed by the patient's symptoms and signs, examination of the URINE, and using investigations such as X-RAYS and ULTRASOUND scans. The interior of the bladder can be examined using a cystoscope, which is a fibreoptic endoscope (see FIBREOPTIC ENDOSCOPY) that is passed into the bladder via the URETHRA.
Most cases of cystitis are caused by bacteria which have spread from the bowel, especially Escherichia coli, entering the bladder via the urethra. Females are more prone to cystitis than are males, owing to their shorter urethra, which allows easier entry for bacteria. Chronic or recurrent cystitis may result in infection spreading up the ureter to the kidney (see KIDNEYS, DISEASES OF).
Typically there is frequency and urgency of MICTURITION, with stinging and burning on passing urine (dysuria), which is often smelly or bloodstained. In severe infection patients develop fever and rigors, or loin pain. Before starting treatment a urine sample should be obtained for laboratory testing, including identification of the invading bacteria.
This includes an increased fluid intake, ANALGESICS such as ibuprofen and doses of potassium citrate to make the urine alkaline to discourage bacterial growth. If appropriate, a course of ANTIBIOTICS is prescribed once a urine sample has been analysed in the laboratory.
The usual reason for the formation of a bladder stone is an obstruction to the bladder outflow, which results in stagnant residual urine – ideal conditions for the crystallisation of the chemicals that form stones – or from long-term indwelling CATHETERS which weaken the natural mechanical protection against bacterial entry and, by bruising the lining tissues, encourage infection.
The classic symptom is a stoppage in the flow of urine during urination, associated with severe pain and the passage of blood.
This involves surgical removal of the stone either endoscopically (litholapaxy); by passing a cystoscope into the bladder via the urethra and breaking the stone; or by LITHOTRIPSY in which the stone (or stones) is destroyed by applying ultrasonic shock waves. If the stone cannot be destroyed by these methods, the bladder is opened and the stone removed (cystolithotomy).
Cancer of the bladder is the fourth most common cancer in men and tenth in women. About 10,000 new cases are diagnosed annually in the UK, mostly in persons aged over 75. In some tropical countries it is caused by the parasitic disease, SCHISTOSOMIASIS.
The classical presenting symptom of a bladder cancer is the painless passing of blood in the urine – haematuria. All such patients with are normally investigated by radiological imaging and with a CYSTOSCOPE.
Superficial bladder tumours on the lining of the bladder can be treated by local removal via the cystoscope (transurethral resection) using DIATHERMY. A single-dose chemotherapy agent is often instilled into the bladder postoperatively. Certain cancers deemed high risk may be treated with a more prolonged chemotherapy course, sometimes including treatment directly to the bladder with BCG VACCINE. Invasive cancers into the bladder muscle may be treated with systemic CHEMOTHERAPY or surgical removal of the bladder (cystectomy).