Hematuria urinary tract tumors

MDCT is a well-established method to delineate and stage TCC. With the introduction of multislice CT scanners, single-breath coverage with thin-slice reconstruction of the whole urinary tract is possible (Figs. 32.1, 32.2). The detection rate for upper and lower urinary tract tumors is comparable to RP and cystoscopy, with sensitivity for the upper urinary tract of up to 92%, and similar sensitivity for the lower tract (Park et al. 2007 Fig. 32.3). With a better detection rate and the multifocal nature of TCC, CTU replaces EU for detection of TCC (Albani et al. 2007). In this study, the usefulness of CT for evaluation of patients with hematuria was evaluated. 

A clinical algorithm for the management of hematuria, for example in patients taking penicillamine or NSAIDs, has been published (238). It should be borne in mind that in such patients hematuria may be symptomatic of underlying pathology (for example a tumor of the urinary tract). 

Balkan nephropathy is a chronic tuhulointerstitial disease with occult, insidious onset, usually progressing slowly with no apparent signs of symptoms. After a long asymptomatic period, the disease is manifested as chronic renal failure. Less commonly hlunt lumbar pain or renal colic may develop or, occasionally, dysuric symptoms induced by urinary tract infechon. If hematuria exists, urothelial tumor should be suspected. In an advanced case polyuria and nocturia are present due to impaired concentrating ability of the kidneys. The disease is tolerated well and the patients preserve their working ability until advanced stages of renal failure [18, 76, 88, 89]. 

Transitional cancer is usually located in the urinary bladder and is diagnosed by means of cystoscopy. Up to 20% of urothelial carcinomas develop in the upper urinary tract, with 25% of these tumors being located in the upper tract of the ureter. The vast majority of the upper-tract TCC are superficial tumors and of low stage. Only about 15% of the upper-tract carcinomas are infiltrating tumors. The patients usually present with hematuria, and in a third of the patients, flank pain and acute renal colic is present. 

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