Bladder polyps question

Hello,
     I am a female, 44, who has had microscopic hematuria for years.  I had a cystoscopy in 1998 which was fine - nothing found, nothing shown on KUB so was assumed I'd had a kidney stone.  No further workups were done at that time.  Every year or so since then, urinalysis at physicals has shown microscopic hematuria.  It was explained to me that some people just have red blood cells in their urine which doesn't amount to anything. (I'm fine with that of course, as long as I'm not missing something important that should be taken care of!):p  Finally, last year I sort of tried again for some resolution to my urinary frequency, back pain, intermittent tissue-like fragments in urine, and the hematuria.  This cystoscopy showed numerous "anemone-like" polyps in the bladder.  My urologist proclaimed them to be a common occurence and said right then that they were benign.  I accepted this happily at the time, not having done any reading about it myself.  Well, (the dreaded internet research) ;) I have read quite a bit since then, and am still rather concerned.  I went back and asked my urologist about removal/biopsy and he said that the resultant bleeding from that (when he says that he can tell just by looking at them that they are benign) means that they are better just left alone.  He told me that he can do follow-up cystoscopies if it would make me feel better, but I guess that wouldn't make me feel better since he already said that the polyps are nothing/benign. He said that my main concern should be attempting to avoid kidney stones (a small one was found on a CT scan).  
     Anyway, I am sorry to ramble on; I guess my main question is this: "ARE there bladder polyps that you can absolutely tell are benign, just by looking at them" -?  From everything I have read, it seems like most urologists think they should all be biopsied or at least removed.  I really like my urologist, but I guess I am a pathetic worrier who needs more assurance.  I have a young child and I really do not want to abandon her any earlier than I absolutely have to ;(
     Thank you for your time! :)

[Kevin Pho, MD]

You cannot have a 100% definitive answer just by looking at the polyp.  However, the experience of the urologist may give you a pretty good idea.  But you're right, if you want a definitive answer, a biopsy would have to be performed.  

Another consideration you may want to do to evaluate the hematuria would be urine cytology - which can sometimes catch bladder cancer.

If you are not confortable with your urologist's approach, another opinion always doesn't hurt.

Followup with your personal physician is essential.

This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.

Kevin, M.D.
Medical Weblog:
kevinmd_b

[susanmk]

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