The Clinical Features About Urinary Bladder Neoplasms Patients Whose Clinical Manifestation Were Lower Urinary Tract Symptoms

Objectives Painless gross hematuria is the first symptom and main clinical manifestation of most bladder malignant tumors,and the following patients with bladder urinary tumors with lower urinary tract symptoms(LUTS)often show dysuria symptoms and bladder irritation expressed as urinary frequency,urgency,and urine,such patients with atypical symptoms and relatively insidious onset,can be misdiagnosed as benign prostatic hyperplasia,urinary tract infection,neurogenic bladder or interstitial cystitis,etc.More tumor progression at diagnosis.This study was designed to analyze the differences in the diagnosis,pathology and treatment of patients with bladder malignancies with LUTS as the primary clinical manifestation or accompanying symptoms and those with no LUTS,and to explore LUTS as the primary clinical manifestation or accompanying Clinical features and diagnosis and treatment of patients with symptoms of bladder malignancy.Methods From July 2016 to July 2018,285 consecutive cases of surgical treatment of bladder tumors in the urology department of the Affiliated Hospital of Qingdao University were collected.The records of the patients with incomplete medical records and 41 patients who were lost to follow-up were excluded.The total number of patients who were included in the study was Of the 244 patients,48 patients with pathologically confirmed malignant tumors and with LUTS as the primary or clinical manifestation were in the LUTS group,and 196 patients without such symptoms were in the non-LUTS group.Analyzing and comparing the differences between the two groups in basic data,test indicators,imaging findings,pathological data and surgical methods.Differences between consecutive variables were compared by t-test,and differences between groups were compared by?~2test,and P<0.05 was statistically significant.ResultsBasic data:There were no significant differences in gender,age,body mass index,smoking history,concomitant hypertension or diabetes,and Benign prostatic hyperplasia(BPH)(P>0.05).Test indicators:There was no significant difference in urinary occult blood and urine white blood cells between the two groups(P>0.05).The positive proportion of urinary exfoliative cytology in the LUTS group was 27.1%.Imaging examination:There was no significant difference in the number of tumors between the two groups(P>0.05).The proportion of patients with tumor diameter greater than 3 cm in the LUTS group was significantly higher than that in the non-LUTS group(?~2=4.245,P=0.039);The main distribution of tumors was statistically different from the control group.The proportion of patients with LUTS group distributed in the bladder triangle and neck and tumors with large bladder was significantly higher than that of the non-LUTS group(?~2=6.674,P=0.036).Pathological data:Compared with the control group,the proportion of patients with carcinoma in situ,mixed urothelial carcinoma and non-urothelial carcinoma was increased in the LUTS group,and the proportion of urothelial carcinoma alone decreased(?~2=8.649,P=0.034).The proportion of Tis,T2,T3 and T4 in the pathological stage of LUTS group was significantly increased,and the proportion of T1 phase was decreased(?~2=8.413,P=0.038).In the classification of urothelial carcinoma,the proportion of high grade urothelial carcinoma in LUTS group Significantly elevated,the proportion of low-grade urothelial neoplasms of low malignant potential(PUNLMP)and low-grade urothelial carcinoma was reduced(?~2=8.330,P=0.016).Treatment:The proportion of radical surgery in the LUTS group was higher than that in the non-LUTS group.The transurethral resection of bladder tumor(TURBT)and partial cystectomy were lower than those in the non-LUTS group(?~2=8.696,P=0.013).Conclusion Compared to patients without bladder malignancies with LUTS as the primary or concomitant symptom,patients with such symptoms have the following characteristics.The positive rate of urinary exfoliative cytology is increased.The proportion of patients with large bladder and neck and tumors with large bladder is increased.The pathological type is special.Patients with carcinoma in situ,mixed urothelial carcinoma and non-urothelial carcinoma proportion is increased,and the proportion of myometrial invasive tumors and high-grade tumors is increased.Prostatic hyperplasia and urinary tract infections have a confusing effect on diagnosis.Imaging studies,urine exfoliative cytology,and cystoscopy biopsy are the main methods for identifying other LUTS symptom diseases and clarifying the diagnosis of such bladder malignancies.In terms of treatment,focal in situ carcinoma and high-grade non-invasive carcinoma are TURBT supplemented with Bacillus calmette-guérin(BCG)perfusion,high-grade and special Pathological types of tumors require radical surgery combined with neoadjuvant chemotherapy and postoperative radiotherapy and chemotherapy.