Key points
The bladder polyps are soft neoformations - benign or malignant - that develop along any tract of the mucosa that internally covers the urinary bladder.
Causes
Symptoms
When symptomatic, bladder polyps begin with purely urinary symptoms. The clinical picture of bladder polyposis is characterized by symptoms such as: alteration of urinary frequency, hematuria, pollakiuria and stranguria.
Diagnosis
The presence of a polyp in the bladder is ascertained through several diagnostic tests: cystoscopy, washing (or irrigation) of the bladder, urine and blood tests, and imaging tests.
Therapy
Even when asymptomatic, bladder polyps require surgical exeresis (removal). Malignant neoformations require further chemotherapy or radiotherapy treatment.
Bladder polyp: what is it?
The bladder polyps (improperly called bladder papillomas ) are abnormal growths that can develop along any stretch of the bladder mucosa. Although they may sometimes be asymptomatic, bladder polyps are often responsible for bleeding and pain during urination. Unlike nasal polyps, the chances that bladder polyps degenerate into a malignant neoplastic form are quite high; therefore, surgical removal is required as soon as possible after the first symptoms appear.
- It is however necessary to underline that not all bladder polyps are malignant.
Generality
The bladder polyps can be single or grow in groups, forming real agglomerates with a shape comparable to a bunch of grapes or a cauliflower. They can measure a few millimeters or they can extend to reach considerable dimensions (some centimeters). Large bladder polyps tend to create more bladder problems than smaller ones.
The bladder polyps can be sessile or pedunculated . In the first case, the polyp is anchored to the bladder mucosa with all its base; otherwise, polyps with peduncles adhere to the same mucosa by a cup-shaped protuberance.
All polyps - sessile or pedunculated, large or small, single or multiple - may have a smooth, irregular or polylobed surface.
Incidence
Men are more exposed to the risk of bladder polyposis than women (approximate incidence of men / women 1.9: 1). Medical statistics show that the average age of onset of bladder polyps is around 57 years.
In general, it is possible to assert that bladder polyposis is a rather rare condition compared to uterine (or endometrial) polyps, intestinal polyps or nasal polyps.
Bladder polyposis represents 3% of all neoplastic forms affecting the bladder.
Causes and risk factors
Unfortunately it is not possible to trace the precise cause triggering the bladder polyposis. Despite the above, an interesting correlation has been observed between smoking and developing bladder polyps.
Smokers seem to be the category most exposed to the risk of bladder polyposis, especially those who live in industrialized and highly polluted areas.
The same applies to hairdressers, miners and workers in the textile, leather and dyes industries, constantly exposed to polycyclic aromatic hydrocarbons (in particular 2-naphthylamine and 4-aminobiphenyl).
What has been said suggests that the above chemicals, together with smoking and smog, can predispose the individual to the disturbance.
Similarly, even those with a history of schistosomiasis or previous history seem to be more affected by bladder polyps than healthy people. The adult stage Schistosoma haematobium parasite dwells in the veins of the bladder plexus, laying its eggs near the bladder wall of the host. In the first stage of infection, it is not uncommon to find the presence of a polyp on the bladder mucosa. For this reason, the hypothesis has been formulated according to which schistosomiasis could constitute a probable etiological factor of bladder polyposis.
- Bladder polyposis triggered by schistosomiasis tends to degenerate into a malignant tumor.
Symptoms
Bladder polyps are not always symptomatic. Many patients in fact, not perceiving the presence of a polyp on the bladder mucosa, become aware of the disease only after a random diagnostic test, performed for other reasons.
However, in most cases, bladder polyposis begins with precise symptoms, such as:
- Alteration of the regular urinary frequency
- Tenderness to palpation on one side of the body (less frequent symptom)
- Painful urination (stranguria)
- Frequent urination (pollakiuria)
- Blood in the urine (hematuria)
Diagnosis
Asymptomatic polyps are discovered accidentally during a routine test, required to ascertain or disprove other disorders.
At the physical-objective examination, the patient is normal. When the presence of a polyp is suspected in the bladder, we proceed with more precise investigative tests. Among all, cystoscopy is one of the most reliable tests ever. Following local urethral anesthesia, we proceed by introducing the endoscope - a thin flexible tube equipped with a tiny video camera and a light source - into the bladder, so as to inspect the inside. The test is normally performed in the urology department. After having ascertained the presence of a polyp in the bladder, the doctor can take a flap of tissue (biopsy); subsequently, the tissue sample will be sent to the laboratory for a cytological investigation.
A sample of cells can also be taken by so-called bladder washing (or irrigation). Using a catheter, we proceed by irrigating the bladder cavity with a physiological solution. In the washing liquid cells of the bladder mucosa can be found, which will be subsequently analyzed under the microscope.
The patient may also be subjected to further urine and blood tests to search for markers of bladder cancer.
Imaging tests (CT and MRI) can be useful to verify the degree of invasion and the location of the polyp on the bladder mucosa.
The differential diagnosis between bladder polyps and all the diseases that are characterized by similar symptoms is a must. At the clinical level, bladder polyposis can in fact be confused with benign prostatic hypertrophy, urinary tract infections associated with venereal diseases and urinary calculi.
Therapy
Although asymptomatic, bladder polyps must be surgically removed, since, over time, they can assume malignant tumor characteristics.
Normally, bladder polyps undergo transurethral resection (TUR), or removal of the bladder polyp with the endoscopic resector. It is an instrument with a metal loop capable of removing the polyp with small fragments. The removal of the lesion is favored by the passage of electric current through the resector. The instrument is inserted directly into the urethra so as to reach the bladder cavity. The intervention requires local or general anesthesia.
When the polyp is diagnosed during an advanced stage (malignant transformation), surgical removal of the bladder is conceivable.
After surgically removing a malignant bladder polyp, the patient is usually subjected to chemo / radiotherapy.
Untreated bladder polyposis (even if asymptomatic) carries a high risk of malignant tumor progression. Such an attitude can worsen the prognosis and put the patient's life at risk.
The bladder polyps can also reform after surgery (marked tendency to post-operative recurrence). In such circumstances, polyps can become increasingly invasive, especially in the case of previous malignant bladder polyps.
