Benign tumors of a bladder
Benign tumors of a bladder – group of the epitelialny and neepitelialny new growths proceeding from various layers of a wall of a bladder and growing in his cavity. Tumors of a bladder can be shown gematuriy various intensity, the speeded-up urination and false desires, morbidity. Diagnosis of tumors of a bladder demands performing ultrasonography, a tsistoskopiya with a biopsy, the descending tsistografiya. Treatment at benign tumors surgical - transurethral removal of new growths, a bladder resection.
Benign tumors of a bladder
Group of benign tumors of a bladder include epitelialny (polyps, papillomas) and neepitelialny (fibromas, leyomioma, rabdomioma, gemangioma, nevrinoma, fibromiksoma) new growths. New growths of a bladder make about 4 — 6% of all tumoral defeats and 10% among other diseases in which diagnosis and treatment the urology is engaged. Tumoral processes in a bladder are diagnosed mainly for persons 50 years are more senior. At men of a tumor of a bladder develop in 4 times more often than at women.
Reasons of development of benign tumors of a bladder
The reasons of development of tumors of a bladder are authentically not found out. The big importance in questions of an etiology is allocated for influence of production vrednost, in particular, of aromatic amines (benzidine, naphthylamine, etc.) as the high percent of new growths is diagnosed for the workers occupied in paint and varnish, paper, rubber, chemical industry.
Long stagnation () of urine can provoke formation of tumors. The orthoaminophenols (products of final exchange of amino acid of tryptophane) which are contained in urine cause proliferation of the epithelium (uroteliya) covering an urinary path. Than longer urine is late in a bladder, and than above its concentration, especially opukholegenny action of the chemical compounds which are contained in it on urotely is expressed. Therefore in a bladder where urine is rather long more often than in kidneys or mochetochnik, different tumors develop.
Men in connection with anatomic features of a structure of an urinogenital path quite often have diseases breaking urine outflow (prostatitis, striktura and diverticulums of an urethra, prostate adenoma, a prostate cancer, an urolithic disease) and there is a high probability of development of tumors of a bladder. In certain cases developing of tumors in a bladder is promoted by cystitis of a virus etiology, trophic, ulcer defeats, parasitic infections ().
Classification of tumors of a bladder
All tumors of a bladder are divided by morphological criterion on malignant and good-quality which, in turn, can have an epitelialny and neepitelialny origin.
Overwhelming part of tumors of a bladder (95%) are epitelialny new growths, of them more than 90% are made by bladder cancer. Papillomas and polyps belong to benign tumors of a bladder. However, reference of epitelialny new growths to good-quality is very conditional as these types of tumors of a bladder have many transitional forms and malignizirutsya quite often. Among malignant new growths infiltriruyushchy and papillary cancer of a bladder meets more often.
Bladder polyps - the papillary educations on the thin or wide fibrovaskulyarny basis covered not changed uroteliy and turned into a bladder gleam. Bladder papillomas – the mature tumors with ekzofitny growth developing from an integumentary epithelium. Macroscopically papilloma has sosochkovy, velvety a surface, a soft consistence, pinkish-whitish color. Sometimes in a bladder multiple papillomas come to light, is more rare - diffusion .
The group of benign neepitelialny tumors of a bladder is presented by fibromas, myomas, fibromiksoma, gemangioma, nevrinoma which in urological practice meet rather seldom. The sarcomas inclined to rapid growth and the early remote metastasis belong to malignant neepitelialny tumors of a bladder.
Symptoms of benign tumors of a bladder
Bladder tumors often develop imperceptibly. As the most characteristic clinical manifestations serve the gematuriya and dizurichesky frustration. Availability of blood in urine can laboratory come to light (mikrogematuriya) or to be a visible eye (makrogematuriya). Gematuriya can be single, periodic or long, but always has to be a reason for the immediate address to the urologist.
The Dizurichesky phenomena usually arise at accession of cystitis and ishuriya (a sharp delay of an urination) are expressed in increase of desires on an urination, tenezma, development of a stranguriya (the complicated urination). Pains at tumors of a bladder are, as a rule, felt over a pubis and in a crotch and amplify at the end of an urination.
The big tumors of a bladder or polyps on a long mobile leg located near a mochetochnik or an urethra can block their gleam and cause violation of depletion of uric ways. Over time it can lead to development of pyelonephritis, a gidronefroz, a chronic renal failure, an urosepsis, uraemia.
Polyps and papillomas of a bladder can be overwound, being followed by sharp violation of blood circulation and a heart attack of a tumor. At a separation of a tumor strengthening of a gematuriya is noted. Tumors of a bladder are the factor supporting recidivous inflammations of uric ways – cystitis, the ascending uretero-pyelonephritises.
The probability of an ozlokachestvleniye of papillomas of a bladder is especially high at smokers. Papillomas of a bladder are inclined to a retsidivirovaniye through various periods of time, at the same time a recurrence differs in a bigger zlokachestvennost, than earlier removed epitelialny tumors.
Diagnosis of benign tumors of a bladder
Ultrasonography, tsistoskopiya, endoscopic biopsy with a morphological research of a bioptat, a tsistografiya, KT is made for identification and verification of tumors of a bladder.
Ultrasonography of a bladder is a noninvasive screening method for diagnostics of new growths, clarification of their arrangement and the sizes. For specification of nature of process it is expedient to supplement ekhografichesky data with a computer or magnetic and resonant tomography.
The main role among the visualizing researches of a bladder is assigned to a tsistoskopiya - endoscopic survey of a cavity of a bubble. Tsistoskopiya allows to examine bladder walls from within, to reveal localization of a tumor, the sizes and prevalence, to execute a transurethral biopsy of the revealed new growth. At impossibility of a fence of a bioptat resort to performance of a cytologic research of urine on atipichesky cages.
Among beam researches at bladder tumors the greatest diagnostic significance is attached to excretory urography with the descending tsistografiya, allowing to estimate in addition a condition of the top urinary tract. In the course of diagnostics tumoral processes should be differentiated with bladder ulcers at tuberculosis and syphilis, endometriosis, metastasises of cancer of uterus and rectum.
Treatment of benign tumors of a bladder
Treatment of asymptomatic neepitelialny tumors of a bladder usually is not required. Observation of the urologist with performance of dynamic ultrasonography and a tsistoskopiya is recommended to patients. At polyps and papillomas of a bladder the operational tsistoskopiya with a transurethral electroresection or electrothermic coagulation of a tumor is carried out. After intervention the bladder kateterization for 1-5 days depending on extensiveness of an operational trauma, prescription of antibiotics, analgetics, spazmolitik is made.
Less often (at ulcers, boundary new growths) there is a need in transvezikalny (on an open bladder) elektroekstsiziya of a tumor, a partial tsistektomiya (an open resection of a wall of a bladder) or a transurethral resection (TOUR) of a bladder.
Forecast and prevention of benign tumors of a bladder
After a resection of tumors of a bladder tsistoskopichesky control is carried out each 3-4 months within a year, within the next 3 years – once a year. Detection of papilloma of a bladder serves as a contraindication to work in harmful industries.
Observance of the drinking mode about the use not less than 1,5 - 2 l of liquid a day belongs to standard measures of prevention of tumors of a bladder; timely depletion of a bladder at desires to an urination, refusal of smoking.