Urothelial carcinoma

Urothelial carcinomas of the bladder are one of the most frequent neoplasms of the urinary tract. The occurrence is gender and age-specific and they are typically encountered in males over 45 years old. Major risk factors include smoking and exposure to aromatic amines. Macrohematuria, urinary obstruction and retention are evocative of urothelial carcinoma but this diagnosis also needs to be considered in patients with microhematuria when glomerulonephritis, urinary tract infections and urinary stones have been excluded by urine sediment analysis and ultrasound scanning The diagnosis of urothelial carcinoma requires histological examination of biopsies obtained during cystoscopy. The therapy depends on the level of invasiveness of the tumor and comprises transurethral resection of the bladder, local instillation of immunomodulators, e. g. BCG for non-invasive tumors and radical cystectomy with adjuvant polychemotherapy containing cisplatin for invasive tumors. Non-invasive tumors are associated with a much higher 5-year survival rate (88%) than invasive tumors (58%).