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Research findings by Upstate urologists may offer insight into possible sign of bladder cancer

Upstate Medical University urologists Timothy Byler, MD, and Imad Nsouli, MD, who also see patients at the Syracuse Veteran Affairs Medical Center, care for many patients who have been referred as a result of incidentally found genitourinary disease.

One afternoon in the office, the two urologists noticed several referrals for isolated bladder wall thickening in the absence of other genitourinary disease. The medical literature contained only one case report and one small series offering no guidance on the proper workup.

Radiologists often see bladder wall thickening while viewing abdominal and pelvic CTs ordered for unrelated complaints, and this has become more common as more computerized tomography scans are performed. More than 80 million CT scans are done annually, compared with fewer than 3 million in 1980, according to Consumer Reports.

Bladder wall thickening may mean a bladder mass, focal bladder wall thickening or diffuse bladder wall thickening. A bladder mass has an element that enters the bladder lumen, but focal bladder wall thickening does not. In diffuse bladder wall thickening, the entire bladder wall is uniformly thicker than usual.

To investigate the significance of these incidental bladder wall abnormalities, Byler and Nsouli built a database of more than 2,400 cystoscopies performed over a 5-year period. Patients who had undergone cystoscopy for blood in the urine, bladder cancer, prostate cancer, or urinary tract infections were excluded. The final study comprised 40 patients who underwent cystoscopy for isolated CT findings of bladder wall thickening.

Expecting the cystoscopy performed in these patients would be negative, the urologists were surprised that nearly 15 percent of the patients were found to have bladder cancer. In addition, half of those patients had a higher risk form of bladder cancer. The cystoscopy may have saved their lives.

Byler and Nsouli then calculated the risk of cancer based on the different CT findings:

• The most suspicious finding is a bladder mass, which carries a 50 percent chance of being cancer.

• None of the patients with focal wall thickening were found to have cancer.

• Almost 20 percent of those patients with diffuse bladder wall thickening had bladder cancer.

Physicians often dismiss diffuse bladder wall thickening, believing the growth is due to a long-term enlarged prostate.

“This data suggests that patients with bladder wall thickening reported should undergo cystoscopy to exclude cancer. If your patient’s CT report comes back with bladder wall thickening, get a urologic consult,” Byler said.

The journal Urology published Byler and Nsouli’s paper on this subject in February.

Reach Byler and Nsouli for consultations by calling 315-464-1500.

—From Physician’s Practice

Caption: A. Shows the normal bladder appearance. Among radiographic bladder wall abnormalities are B. diffuse bladder wall thickening, C. focal bladder wall thickening and D. bladder mass.

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