Bladder Cancer

[MadameButterfly]

After noticing some mild urinary burning with urination for about a week, I experienced an incidence of painless Haematuria.  There was a substantial amount of blood visible in a one off incident (i.e. occuring one evening upon urgency to urinate 3 times within 5-15 minutes of each time...each time the amount of blood visible upon urinating diminished in that it became less'red' and more brown).  A followup urine test in doctor's office next day revealed microscopic haematuria, and a diagnosis of urinary tract infection was made and treated with antibiotics.  

Although there was no further visible blood upon urinating, nor any further burning, I requested additional testing after a week for more information about the initial profuse amount of blood I had urinated.  I had early morning urine tests with the following notations in two out of the 3 samples: #1=no results reported; #2 specimen 50ml=Inconclusive "A few reactive type urothelial cells present (SNOMED CODES A: T7X100, D: T70135); #3 specimen 35ml=Supicious for Malignancy "Atypical urothelial cells with high nuclear/cytoplasmic ratios seen in smal papillary-type clusters, suspicious for Transitional Cell Carcinoma" (SNOMED CODES A: T7X100, C: M80003, D: M69700, M69760, M80413, M81203, T70135).  

Subsequently I had a cystoscopy performed in January.  RESULTS:  EUA-Healthy vulvovaginal tissues, Cervix soft and normal, Other pelvic structures normal with no significant abnormal features.  CYSTOURETHROSCOPY-Normal urethra and bladder neck. The bladder interior was completely normal.  The UO's were normal with clear efflux.  The urine in the bladder was clear and approximately 50ml. Bilateral renal pelvic washings were performed using a 4 Fr ureteric catherer.

The cytology report for the renal washings reported as follows: 5ml of fluid specimen Unsatisfactory (SNOMED CODES A: T71000, B: M09010), Non-Diagnostic, No cells seen.  Prior to my seeing these results, my Urologist reported to me the the cystoscopy showed no signs of bladder cancer and having done the bladder and kidney washings there were no cells evident as per initial pathology reports (he did not tell me at that time that the specimen was inadequet/unsatisfactory for diagnosis!)

It has been suggested by Urologist that having found no evidence of Transitional Cell cancer of urinary tract, I repeat the early morning urine tests in 6 months time and a further cystoscopy later this year.  Meanwhile, the urologist has diagnosed chronis inflammation of the bladder (cystisis).

Since there are contradicatory reports from the #3 pathology report on the early morning urines, and the cystoscopy report along with the resultant insufficiently diagnostics from the renal washings of the cystoscopyy, my questions are:-
#1 Should I now seek a second opinion (e.g. have a cystoscopy performed elsewhere)?
#2 In seeking a second opinion what other or further testing might be advisable, if not simply another cystosopy performed by a different specialist (?perhaps with more sophisticated equipment?)?
#3 If the conflicting results as reported above are not suspect, why would the #3 early morning urine patholgy show such suspicious results whilst the cystoscopy showed reportedly perfectly normal bladder/urinary tract/kidney scopings and/or washings?

Sandi


This discussion is related to Atypical urothelial cells.