A bladder lesion is defined as any abnormal area or growth that develops on the lining or within the wall of the urinary bladder. The term encompasses a wide spectrum of tissue abnormalities, ranging from simple inflammation to complex tumors. These abnormalities require careful attention because their appearance alone does not indicate their underlying nature or potential for harm.
Classifying Bladder Lesions
Bladder lesions are categorized based on their cellular behavior, separating them into non-cancerous (benign) and cancerous (malignant) types. This distinction determines the potential for spread and the necessary course of management. Malignant lesions, often referred to as bladder cancer, primarily arise from the urothelial cells lining the bladder’s inner surface.
The most frequent form of malignancy is transitional cell carcinoma, also known as urothelial carcinoma, accounting for the vast majority of bladder cancer cases. These growths are further classified by how deeply they invade the bladder wall, which directly impacts the prognosis. Benign lesions do not invade the deeper muscle layers or spread to distant sites in the body.
Benign growths are relatively uncommon but include formations like papillomas, which are small, wart-like growths arising from the urothelium. Other examples include inverted papillomas, which grow inward, and smooth muscle tumors such as leiomyomas. Fibromas, hemangiomas, and lipomas originate from connective tissue, blood vessels, or fat cells. While these benign lesions do not metastasize, they can cause urinary symptoms if they become large or obstruct urine flow.
Common Symptoms and When to Seek Medical Help
The most common symptom of a bladder lesion is hematuria, the presence of blood in the urine. This blood may be visibly noticeable (gross hematuria), causing the urine to appear pink, red, or cola-colored, or it may be microscopic, detectable only through laboratory testing.
Other indicators involve changes in urination patterns, including dysuria (pain or burning sensation during urination). Patients may also experience increased urinary frequency, a sudden urge to urinate (urgency), or difficulty passing urine. If a lesion is large or located near the bladder outlet, it can cause persistent lower abdominal or pelvic pain.
Seek prompt medical consultation for any episode of visible hematuria, even if it resolves quickly. This symptom holds particular significance as it is the presenting sign in the majority of patients diagnosed with bladder cancer. Persistent or recurrent unexplained urinary symptoms, especially when accompanied by fatigue, unexplained weight loss, or pain in the side or back, warrant immediate evaluation.
How Bladder Lesions Are Diagnosed
The diagnostic process begins with laboratory tests to check for microscopic abnormalities. A urinalysis looks for red blood cells or infection, followed by urine cytology, where a sample is examined to detect abnormal cells shed from the bladder lining.
The definitive procedure for evaluating the bladder is cystoscopy. During this procedure, a thin, flexible tube (a cystoscope) is inserted through the urethra, allowing the physician to visually inspect the entire interior surface. This technique allows for the localization, size estimation, and initial characterization of any suspicious lesions.
Imaging studies assess the upper urinary tract and determine the extent of a lesion. Computed Tomography (CT) urography uses contrast dye to produce detailed images of the kidneys, ureters, and bladder, useful for detecting co-existing tumors or evaluating lymph nodes. Ultimately, a biopsy is essential to confirm the diagnosis and determine whether the cells are benign or malignant.
Treatment Options Based on Lesion Type
The approach to treatment depends on the lesion’s classification, size, location, and cellular grade. For many benign lesions, treatment may involve simple surveillance, where the lesion is monitored over time with periodic cystoscopies. If a benign lesion causes symptoms like pain or obstruction, it can be removed endoscopically using cauterization or simple resection.
For malignant lesions, the initial treatment is Transurethral Resection of Bladder Tumor (TURBT), a surgical procedure performed through the urethra. The TURBT removes the visible tumor and obtains tissue samples to determine the cancer’s depth of invasion and grade. If the cancer is non-muscle invasive (confined to the inner lining), TURBT may be followed by intravesical therapy.
Intravesical therapy involves instilling a liquid drug, such as chemotherapy agents or the immunotherapy Bacillus Calmette-Guérin (BCG), directly into the bladder via a catheter. BCG is highly effective for high-risk non-muscle invasive disease, prompting the body’s immune system to attack the cancer cells and reducing the risk of recurrence. If the cancer is muscle invasive, more aggressive treatment is required, including radical cystectomy (surgical removal of the entire bladder), often paired with systemic chemotherapy.