Urologist Misses Diagnosis of Invasive Bladder Cancer

This urologic oncology case involves a fifty-six-year-old man who was undergoing treatment for urinary frequency, nighttime urination, and occasional blood in the urine. The urologist performed a cystoscopy and diagnosed the patient with an overactive bladder and benign prostatic hypertrophy. The patient was seen every three to four months due to the waxing and waning of symptoms, but he consistently had blood in his urine. The patient got a second opinion from a pathologist who identified cancer cells in a cytology evaluation. After identification of the suspicious cells, the urologist performed a second cystoscopy, which revealed invasive bladder cancer. The patient required a bladder reconstruction procedure, and continued to suffer from a decreased quality of life.

Question(s) For Expert Witness

1. How helpful is a basic urine cytology in pointing toward a diagnosis of bladder cancer?

Expert Witness Response

All patients with gross and microscopic hematuria should have a urinary cytology and cystoscopy done. Urinary cytology is often the test used for diagnosis if a malignancy is present. If the urine cytology is suggestive of a malignancy, then the urologist should pursue performing a cystoscopy and possibly bladder biopsy. Urinary cytology is most helpful in diagnosing high-grade tumors. While this is an important diagnostic tool, it should be highlighted that low-grade, noninvasive tumors may be missed by routine cytologic analysis and thus will require a cystoscopy for further evaluation.