Banner Image: Dr. Neal Shore, a member of the BCAN Board of Directors, speaks with a patient about diagnosing and monitoring bladder cancer.
Cystoscopy: The Gold Standard
Although radiological tests provide important information about the kidneys and the ureters, cystoscopy is the best method of evaluating the bladder and the urethra and diagnosing and monitoring bladder cancer. 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.
Click here to read our Get the Facts | Cystoscopy (PDF), filled with advice from patients who have experienced it.
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). A CT urogram examines the upper urinary tract (kidneys and ureters) in detail.
This test is good at finding tumors of the kidney, renal pelvis, and ureter, as well as other urologic abnormalities. It 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. In patients with cancer, it will help identify signs of spread to lymph nodes or other organs like the liver.
Your healthcare provider will request blood work to see if you have normal kidney function 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 procedure called cystoscopy with retrograde pyelograms may be suggested. The urologist performs x-rays while injecting dye into the ureters. 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.
Another option for imaging is MRI of the abdomen and pelvis or MR Urogram. This test is also effective at finding tumors in the kidney and ureters and evidence of spread of cancer. It may be used to avoid radiation or in patients with contrast dye allergies or borderline kidney function. It is not quite as good at finding kidney stones and similar to CT urogram may miss tumors in the bladder such that patients still require cystoscopy.
Renal ultrasound is the least invasive way to evaluate the kidneys. It does not require radiation and avoids contrast. It may be used in lower risk patients and those with contrast allergies or poor renal function. Unfortunately, it can miss small kidney stones and tumors. Also, it will not detect tumors in the ureter unless they are causing a blockage leading to hydronephrosis.