@UrologyQuiz Quiz4 Follow-up MCQs: (ANSWERS BELOW!) 1.

Urothelial (Transitional cell) carcinoma of the bladder- all are TRUE except: A) Often has painless haematuria B) May have microscopic rather than macroscopic haematuria C) Is always associated with imaging changes D) Often requires cystectomy with higher stage disease 2. On ultrasound all of the following are differential diagnoses of a mass originating in the bladder wall A) Bladder Cancer (primary urothelial or other e.g. mesenchymal, secondary) B) Prostate malignancy or benign C) Bladder papilloma (benign) D) Bladder stone 3) A bladder mass with haematuria once found on ultrasound MAY initially best be appropriately investigated with: A) Retrograde pyelography, cystoscopy +/- cytology B) Cystoscopy only C) Urine cytology and a CTIVP only D) None of the above

ANSWERS
Q1 Answer C: bladder tumours may be subtle whilst carcinoma-in-situ (CIS) almost invisible to imaging so incorrect. Rest A, B and D fairly obviously correct Q2 Answer D: Bladder stones will be hyperechoic with acoustic shadowing when visible and so should not be mistaken for cancer- they are also mobile. However it must be remembered that Cancers are generally isoechoic as in the case of quiz 4 but occasionally parts may be hyperechoic if calcified and hence could be mistaken as a stone. Answers A-c all good differentials of mass arising from bladder wall Q3 Answer A: Ultrasound is actually a valuable tool in diagnosis of haematuria (despite what some references state). The caveat is that carcinoma-in-situ (CIS) and subtle masses will be missed necessitating cystoscopy and upper tract imaging in almost every case. If renal tract ultrasound primary modality available must be supplemented with retrograde pyelography- CTIVP can be done but not essential: see EAU guidelines http://www.uroweb.org/guidelines/onlineguidelines/ The BAUS guidelines state Imaging and cystoscopy for hematuria (haematuria) investigation http://www.baus.org.uk/AboutBAUS/publications/haematuria-guidelines. B) must image upper tracts, C) must have cystoscopy!