Clinical significance




Inflammation and infectionedit

Cystitis refers to infection or inflammation of the bladder. It commonly occurs as part of a urinary tract infection. In adults, it is more common in women than men, owing to a shorter urethra. It is common in males during childhood, and in older men where an enlarged prostate may cause urinary retention. Other risk factors include other causes of blockage or narrowing, such as prostate cancer or the presence of vesico-ureteric reflux; the presence of outside structures in the urinary tract, such as urinary catheters; and neurologic problems that make passing urine difficult. Infections that involve the bladder can cause pain in the lower abdomen (above the pubic symphysis, so called "suprapubic" pain), particularly before and after passing urine, and a desire to pass urine frequently and with little warning (urinary urgency). Infections are usually due to bacteria, of which the most common is E coli.

When a urinary tract infection or cystitis is suspected, a medical practitioner may request a urine sample. A dipstick placed in the urine may be used to see if the urine has white blood cells, or the presence of nitrates which may indicate an infection. The urine specimen may be also sent for microbial culture and sensitivity to assess if a particular bacteria grows in the urine, and identify its antibiotic sensitivities. Sometimes, additional investigations may be requested. These might include testing the function of the kidneys by assessing electrolytes and creatinine; investigating for blockages or narrowing of the renal tract with a ultrasound, and testing for an enlarged prostate with a digital rectal examination.

Urinary tract infections or cystitis are treated with antibiotics, many of which are consumed by mouth. Serious infections may require treatment with intravenous antibiotics.

Interstitial cystitis refers to a condition in which the bladder is infected due to a cause that is not bacteria.citation needed

Incontinence and retentionedit

Frequent urination can be due to excessive urine production, small bladder capacity, irritability or incomplete emptying. Males with an enlarged prostate urinate more frequently. One definition of an overactive bladder is when a person urinates more than eight times per day. An overactive bladder can often cause urinary incontinence. Though both urinary frequency and volumes have been shown to have a circadian rhythm, meaning day and night cycles, it is not entirely clear how these are disturbed in the overactive bladder. Urodynamic testing can help to explain the symptoms. An underactive bladder is the condition where there is a difficulty in passing urine and is the main symptom of a neurogenic bladder. Frequent urination at night may indicate the presence of bladder stones.

Disorders of or related to the bladder include:

  • Bladder exstrophy
  • Bladder sphincter dyssynergia, a condition in which the sufferer cannot coordinate relaxation of the urethra sphincter with the contraction of the bladder muscles
  • Paruresis
  • Trigonitis
  • Urinary retention

Disorders of bladder function may be dealt with surgically, by re-directing the flow of urine or by replacement with an artificial urinary bladder. The volume of the bladder may be increased by bladder augmentation. An obstruction of the bladder neck may be severe enough to warrant surgery.

Canceredit

Cancer of the bladder is known as bladder cancer. It is usually due to cancer of the urothelium, the cells that line the surface of the bladder. Bladder cancer is more common after the age of 40, and more common in men than women; other risk factors include smoking and exposure to dyes such as aromatic amines and aldehydes. When cancer is present, the most common symptom in an affected person is blood in the urine; a physical medical examination may be otherwise normal, except in late disease. Bladder cancer is most often due to cancer of the cells lining the ureter, called transitional cell carcinoma, although it can more rarely occur as a squamous cell carcinoma if the type of cells lining the urethra have changed due to chronic inflammation, such as due to stones or schistosomiasis.

Investigations performed usually include collecting a sample of urine for an inspection for malignant cells under a microscope, called cytology, as well as medical imaging by a CT urogram or ultrasound. If a concerning lesion is seen, a flexible camera may be inserted into the bladder, called cystoscopy, in order to view the lesion and take a biopsy, and a CT scan will be performed of other body parts (a CT scan of the chest, abdomen and pelvis) to look for additional metastatic lesions.

Treatment depends on the cancer's stage. Cancer present only in the bladder may be removed surgically via cystoscopy; an injection of the chemotherapeutic mitomycin C may be performed at the same time. Cancers that are high grade may be treated with an injection of the BCG vaccine into the bladder wall, and may require surgical removal if it does not resolve. Cancer that is invading through the bladder wall may be managed by complete surgical removal of the bladder (radical cystectomy), with the ureters diverted into a segment of part of ileum connected to a stoma bag on the skin. Prognosis can vary markedly depending on the cancer's stage and grade, with a better prognosis associated with tumours found only in the bladder, that are low grade, that don't invade through the bladder wall, and that is papillary in visual appearance.

Investigationedit

A number of investigations are used to examine the bladder. The investigations that are ordered will depend on the taking of a medical history and an examination. The examination may involve a medical practitioner feeling in the suprapubic area for tenderness or fullness that might indicate an inflammed or full bladder.citation needed Blood tests may be ordered that may indicate inflammation; for example a full blood count may demonstrate elevated white blood cells, or a C-reactive protein may be elevated in an infection.citation needed

Some forms of medical imaging exist to visualise the bladder. A bladder ultrasound may be conducted to view how much urine is within the bladder, indicating urinary retention. A urinary tract ultrasound, conducted by a more trained operator, may be conducted to view whether there are stones, tumours or sites of obstruction within the bladder and urinary tract. A CT scan may also be ordered.

A flexible internal camera, called a cystoscope, can be inserted to view the internal appearance of the bladder and take a biopsy if required.

Urodynamic testing can help to explain the symptoms.

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The urinary bladder , or simply bladder , is a hollow muscular organ in humans and other vertebrates that stores urine from the kidneys before disposal by urination. In the human the bladder is a hollow muscular, and distensible organ that sits on the pelvic floor. Urine enters the bladder via the ureters and exits via the urethra. The typical human bladder will hold between 300 and 500 ml (10.14 and 16.91 fl oz ) before the urge to empty occurs, but can hold considerably more. The Latin phrase for "urinary bladder" is vesica urinaria , and the term vesical or prefix vesico - appear in connection with associated structures such as vesical veins. The modern Latin word for "bladder" – cystis – appears in associated terms such as cystitis (inflammation of the bladder).
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