Benign bladder tumors are a group of epithelial and non–epithelial neoplasms originating from various layers of the bladder wall and growing inside its cavity. Neoplasia can be manifested by hematuria of varying intensity, frequent urination and false urges, soreness. Diagnosis requires ultrasound, cystoscopy with biopsy, descending cystography. Treatment for benign tumors is surgical – transurethral removal of neoplasms, resection of the bladder.
Meaning
The group of benign tumors of the bladder includes epithelial (polyps, papillomas) and non-epithelial (fibroids, leiomyomas, rhabdomyomas, hemangiomas, neurinomas, fibromyxomas) neoplasms. Neoplasms of the bladder account for about 4-6% of all tumor lesions and 10% among other diseases, which are diagnosed and treated by specialists in the field of clinical urology. Tumor processes in the bladder are diagnosed mainly in people over 50 years of age. In men, bladder tumors develop 4 times more often than in women.
Causes
The causes of the development of bladder tumors have not been reliably clarified. Great importance in matters of etiology is given to the effects of industrial hazards, in particular, aromatic amines (benzidine, naphthylamine, etc.), since a high percentage of neoplasms are diagnosed in workers employed in the paint, paper, rubber, chemical industries.
Prolonged stagnation (stasis) of urine can provoke the formation of tumors. Orthoaminophenols contained in urine (products of the final metabolism of the amino acid tryptophan) cause proliferation of the epithelium (urothelium) lining the urinary tract. The longer the urine lingers in the bladder and the higher its concentration, the more pronounced the tumor-causing effect of the chemical compounds contained in it on the urothelium. Therefore, in the bladder, where urine is relatively long, more often than in the kidneys or ureters, various kinds of tumors develop.
In men, due to the anatomical features of the structure of the genitourinary tract, diseases that disrupt the outflow of urine quite often occur (prostatitis, strictures and diverticula of the urethra, prostate adenoma, prostate cancer, urolithiasis) and there is a high probability of developing bladder tumors. In some cases, the appearance of tumors in the bladder is facilitated by cystitis of viral etiology, trophic, ulcerative lesions, parasitic infections (schistosomiasis).
Pathanatomy
Bladder polyps are papillary formations on a thin or wide fibrovascular base, covered with unchanged urothelium and facing into the lumen of the organ. Bladder papillomas are mature tumors with exophytic growth developing from the integumentary epithelium. Macroscopically, the papilloma has a papillary velvety surface, soft consistency, pinkish-whitish color. Sometimes multiple papillomas are detected in the bladder, less often diffuse papillomatosis.
Classification
According to the morphological criterion, all benign tumors of the bladder are divided into epithelial and non-epithelial. The vast majority of neoplasms (95%) are epithelial. Benign epithelial neoplasia includes papillomas and polyps. These types of tumors have many transitional forms and are quite often malignized. In addition, the group of benign non-epithelial neoplasms of the bladder is represented by fibroids, fibroids, fibromyxomas, hemangiomas, neurinomas, which are relatively rare in urological practice.
Symptoms
Bladder tumors often develop unnoticed. The most characteristic clinical manifestations are hematuria and dysuric disorders. The presence of blood in the urine can be detected in the laboratory (microhematuria) or be visible to the eye (macrohematuria). Hematuria can be single, periodic or prolonged, but it should always be a reason for immediate treatment by a urologist.
Dysuric phenomena usually occur with the addition of cystitis and are expressed in increased urge to urinate, tenesmus, the development of stranguria (difficulty urinating), ischuria (acute urinary retention). Pain with bladder tumors, as a rule, is felt above the pubis and in the perineum and increases at the end of urination.
Complications
Large tumors of the bladder or polyps on a long movable leg, located near the ureter or urethra, can block their lumen and cause a violation of the emptying of the urinary tract. Over time, this can lead to the development of pyelonephritis, hydronephrosis, chronic renal failure, urosepsis, uremia. Polyps and papillomas can twist, accompanied by acute circulatory disorders and tumor infarction. When the tumor is detached, an increase in hematuria is noted.
Neoplasms are a factor supporting recurrent inflammation of the urinary tract – cystitis, ascending uretero-pyelonephritis. The probability of papilloma malignancy is especially high in smokers. Bladder papillomas are prone to relapse after various periods of time, while relapses are more malignant than previously removed epithelial neoplasia.
Diagnostics
To identify and verify bladder tumors, cystoscopy, endoscopic biopsy with morphological examination of the biopsy, cystography, CT. Ultrasound of the bladder is a non-invasive screening method for diagnosing neoplasms, determining their location and size. To clarify the nature of the process, it is advisable to supplement the echographic data with computer or magnetic resonance imaging of the pelvic organs with contrast.
The main role among visualizing studies of the bladder is assigned to cystoscopy – endoscopic examination of the bladder cavity. Cystoscopy allows you to examine the walls of the bladder from the inside, identify the localization of the tumor, size and prevalence, perform a transurethral biopsy of the detected neoplasm. If it is impossible to take a biopsy, they resort to performing a cytological examination of urine for atypical cells.
Among radiation studies, the greatest diagnostic value is attached to excretory urography with descending cystography, which allows to additionally assess the condition of the upper urinary tract. In the process of diagnosis, tumor processes should be differentiated with bladder ulcers in tuberculosis and syphilis, endometriosis, metastases of uterine and rectal cancer.
Treatment
Treatment of asymptomatic non-epithelial tumors is usually not required. Patients are recommended to be monitored by a urologist with dynamic ultrasound and cystoscopy. With polyps and papillomas of the bladder, surgical cystoscopy is performed with transurethral electrosection or electrocoagulation of the tumor. After the intervention, the bladder is catheterized for 1-5 days, depending on the extent of the surgical injury, the appointment of antibiotics, analgesics, antispasmodics. A modern minimally invasive technique is laser en-bloc resection, which allows to remove the formation with the capture of the muscle layer, which is extremely important for subsequent histological examination.
Less often (with ulcers, borderline neoplasms), there is a need for transvesical (open bladder) electroexcision of the tumor, partial cystectomy (open resection of the bladder wall) or transurethral resection (TUR) of the bladder.
Prognosis and prevention
After resection of bladder tumors, cystoscopic control is performed every 3-4 months for a year, for the next 3 years – 1 time a year. Detection of bladder papilloma serves as a contraindication to work in harmful industries. The standard preventive measures include compliance with a drinking regime with the use of at least 1.5 – 2 liters of liquid per day; timely emptying of the bladder when urinating, quitting smoking.
