What causes black spots in urine

Doctor's letter : Bladder cancer

EXPLANATION The urinary bladder is a muscular-lined organ in which urine collects and is stored until it is emptied. The urine is produced by the kidneys, which detoxify the body. Waste products such as ammonia from the metabolism or traces of medication are contained in the urine. A tumor can develop in the lining that lines the urinary bladder. Bladder cancer can not only significantly impair urination - in the worst case scenario, the disease can also be fatal.

In Germany around 28,000 people are currently diagnosed with bladder cancer every year. However, experts have been observing for some time that the number of cases of illness is steadily increasing. This cancer particularly affects men. Mario Zacharias, head physician at the Urology Clinic at the Vivantes Auguste Viktoria Clinic, estimates that up to 80 percent of patients are male. Every year around 7,000 people die of the disease in this country. Tobacco consumption is held responsible for around half of the cases.

SYMPTOMS Pain, for example in the abdomen or in the bones, occurs in bladder cancer only at an advanced stage. "Blood in the urine is the first characteristic symptom of bladder cancer," says Zacharias. Frequent need to urinate and painful urination could also indicate cancer. Chronic urinary bladder inflammation is a warning signal for older people.

CAUSES Tobacco consumption is blamed for 25 to 50 percent of all cases of illness. The toxins collect in the bladder and have a long-term effect on it. "The abuse of painkillers and chronic inflammation of the urinary bladder can also cause the tumor," says Zacharias. “Other triggers can be certain chemicals with which the patient is frequently in contact, for example at his workplace.” For example, aromatic amines - organic nitrogen compounds - are considered carcinogenic and have been linked to the development of bladder cancer. For a worker in the textile, dye or chemical industry who has been in contact with one or more harmful substances for many years, bladder cancer is therefore considered an occupational disease. However, the cancer usually develops over a long period of time. A weakened immune system can also promote bladder cancer. Even people who have to wear a urinary catheter permanently have a higher risk of developing a malignant tumor in the bladder. Bladder cancer can also be genetic.

DIAGNOSIS To diagnose the tumor, the doctor first takes a urine sample and tests it for blood. An ultrasound scan is used to search the bladder for clots and lumps. During a cystoscopy via the urethra, tissue samples are taken from the bladder lining. "If a tumor can be identified, it is removed, so to speak, planed off with an electronic snare that is inserted through the urethra via a tube," says Zacharias. The histopathologist then examines the sample in the laboratory and determines how deep and harmful the tumor is. This planing method is both diagnostic and therapeutic. Because in some cases the tumor can already be completely removed.

THERAPY In around 80 percent of patients, the tumor has not yet spread from the mucous membrane that lines the bladder to the underlying bladder muscles at the time of diagnosis. "If the tumor is superficial, it can be ablated and removed through the urethra," says chief physician Zacharias. The hospital stay required for this usually lasts between two and three days. If the doctor fears that the tumor will return after the procedure, he recommends subsequent local chemotherapy. If a patient has already had multiple bladder cancer, immunotherapy can prevent new tumors from growing. Medicines are injected into the bladder for up to three years to strengthen the immune system.

In about ten percent of the cases, that's not enough. "If the tumor has already affected the muscles under the mucous membrane, the bladder must be completely or partially removed," says the bladder cancer expert. For patients with this so-called muscle-invasive carcinoma, a new bladder must then be formed. “The way the new bladder is made should be tailored to the individual patient,” says Zacharias. Surgeons often use a piece of intestine that is reshaped and connected to the urethra. In addition, the surrounding lymph nodes, through which the cancer could spread, are removed.

In addition to the urinary bladder and lymph nodes, surrounding organs must also be removed. In men, the surgeon must also remove the prostate and seminal vesicles; in women, the uterus, both ovaries and fallopian tubes, and part of the vaginal wall. This procedure leads to infertility in both men and women.

If the urethra is already affected, it must also be removed. Then it is possible to put an artificial urine outlet directly over the navel. With such an outcome, however, the patient must first learn to live, says Zacharias. A possible alternative is the drainage of the urine through the intestine. Zacharias therefore recommends that patients decide together with the resident urologist and relatives which solution is best for their individual case.

If metastases, i.e. daughter tumors, have already formed in the lungs, liver or bones, the cancer can no longer be cured. Then the main aim of treatment is to fight the disease, delay its development and thus give those affected the longest possible survival time, says chief physician Zacharias.

If the cancer is successfully removed, the danger is not completely averted. "Bladder cancer tends to come back," says the expert. "In order to detect a new tumor in good time, regular check-ups are necessary." During this process, regular cystoscopy is performed. The frequency of follow-up checks depends on the spread of the tumor and the type of treatment. In addition, after a bladder removal, a stay in a follow-up clinic specializing in bladder cancer can be helpful.

There are no hard and fast rules to prevent the disease. In any case, quitting smoking reduces the risk. The urologist also recommends drinking a lot and not leaving the urine in the bladder for too long. "Drinking cranberry juice now and then can help cleanse the bladder," advises the doctor. However, this cannot prevent the development of bladder cancer.

So far, fewer people have suffered from bladder cancer than other cancers. For this reason, no preventive method such as that used for other cancers has yet established itself. A cystoscopy is firstly very uncomfortable for the patient and secondly too time-consuming to carry out preventively on all people at regular intervals, says Zacharias.

The editors of the magazine "Tagesspiegel Kliniken Berlin 2016" compared the Berlin clinics that treat this disease. For this purpose, the treatment numbers, the hospital recommendations of the outpatient doctors and the patient satisfaction were compiled in clear tables in order to make it easier for the patient to choose a clinic. The magazine costs 12.80 euros and is available in the Tagesspiegel shop.

To home page