Bladder cancer involves rapid abnormal cell growth within the lining of the bladder. There are different types of these cells so more than one kind of cancer can develop at the same time in different parts of the bladder. 80% of bladder cancers are diagnosed early and usually curable if treated in this stage, when the cancer cells are still contained within the bladder.

Symptoms
In the case of bladder tumors, several signs and symptoms may occur, the most common is detection of blood in the urine (hematuria). Most patients with bladder cancer do not feel sick and the disease is detected only after careful evaluation. The amount of blood discovered does not indicate the severity of disease; however, both small amounts of blood detected by your physician as well as blood that you can see can indicate the presence of cancer. While microscopic blood in the urine, microscopic hematuria, is the single most common sign, it is important to point out that most individuals who have microscopic hematuria DO NOT have bladder cancer. 

Other symptoms that can be present include urinary urgency or frequency, weight loss, loss of appetite and abdominal pain.

Beyond examining the urine microscopically for traces of blood, a finding of far greater specificity for the detection of transitional cell carcinoma is the detection of actual cancerous-appearing cells in the urine. 

Evaluation
While the majority of hematuria is from benign or non-cancerous causes, it is important to undergo a thorough evaluation to determine its cause. In general, the evaluation of hematuria will include a cystoscopic or direct examination of the bladder mucosa by your urologist, a CT scan of the abdomen, and a urine evaluation (cytology) to identify cancer cells. Urine cytology is very similar to the Pap smear used to identify cervical cancer in women. A positive test warrants a thorough evaluation to locate the cancer. 

Once the diagnosis has been made, it is important to discern the extent of its growth within the bladder wall and rule out spread to adjacent organs. This process is known as staging and will involve surgical resection of the tumor, which is generally done on an outpatient basis. Our surgeons have extensive experience in the diagnosis and treatment using minimally invasive techniques. 

Treatment Options
Treatment options differ depending on the type of cancer discovered and the degree of involvement of the bladder wall. A summary of the major types of cancer and their treatments are listed below.

Carcinoma in situ (CIS) 
CIS may affect the entire bladder mucosa. Therefore, the therapy directed to its eradication must treat the entire mucosal surface. Bacille Calmette-Guerin (BCG) is a weakened strain of Mycobacterium bovis - a cousin of the organism primarily responsible for tuberculosis. When instilled as a solution into the bladder - known as intravesical therapy - the body recognizes this foreign agent and a powerful immune response ensues which eradicates the disease. 

Superficial invasive TCC 
The primary treatment for superficial TCC is transurethral resection of the bladder tumor (TURBT) or transurethral fulguration. Using a similar instrument as is used for cystoscopy, your urologist locates and visualizes the tumor within the bladder. A small wire loop protrudes from the cystoscope and is connected to an electrical source to carefully and precisely resect (cut out) the tumor. On occasion, the tumor may be so small or superficial that a fulguration or simple burning of the abnormal tissue will suffice.

Muscle invasive TCC 
Once a bladder tumor has penetrated into the muscle layer, the ability to completely resect it via TURBT becomes more difficult, if not impossible. This type of tumor is treated by removing the bladder and diverting the urine via a continent or non-continent mechanism. Your physician will review the options in detail.

Possible Causes and Prevention
There are no known causes for bladder cancer. Tobacco, however, has proven to be a primary risk factor. Quitting smoking is the best action you can take to reduce your risk of bladder cancer.

Incontinence is the accidental release of urine that often occurs with a cough, laugh or sneeze. Patients can also experience sudden urges to go to the bathroom and can't get there in time. Incontinence is not a disease, nor is it a life-threatening condition. It is a problem with the lower urinary tract that is, in most cases, easily treatable.

Types of Incontinence
There are three common types of incontinence. It is important to know what type of incontinence you have so the root causes can be treated appropriately.

Overactive bladder, also called urge incontinence, is a bladder storage problem, in which the bladder contracts suddenly and inappropriately. You feel it as a frequent and overpowering urge to go to the toilet, night and day, followed by a powerful and uncontrollable bladder contraction. If the muscles that keep your urethra closed are weak, you won't make it to the toilet in time. This is overactive bladder- wet (also called urge urinary incontinence). If your pelvic muscles are fit, you normally will get there in time. This is overactive bladder- dry (or, simply put, just urgency).

Stress incontinence is also a bladder storage problem in which the muscles that normally stop the flow of urine are too weak to stop it when pressure is exerted on the bladder from the abdomen above.   This causes you to leak urine as you stand up, or get out of a car, lift a heavy object, exercise, cough, sneeze, or laugh. Any action that creates downward pressure on the bladder and urethra or increases intra-abdominal pressure can cause you to leak urine.

In mixed incontinence, not only do you leak when you lift, you never want to find yourself where you can't find a toilet. You have symptoms of both stress urinary incontinence and an overactive bladder.

Treatment Options
In most cases, incontinence can be significantly improved or cured altogether. Patients should start with a conservative course of action, such as pelvic floor therapy, behavior modification and bladder to decrease symptoms. Other treatment options include medication and a variety of surgical solutions.

Possible Causes and Prevention
Many women simply accept incontinence as a common side effect of growing older. This should NOT be the case. Incontinence is not normal and can be caused by:

• Childbirth, weight gain or any conditions that stretch and weaken the pelvic floor muscles
• Over activity of the bladder, which may be due to bladder irritants such as caffeine or spicy food, emotional stress or neurological problems
• Incontinence can be prevented by maintaining pelvic floor strength with daily Kegel (pelvic floor) exercises and/or avoiding bladder irritants.

Resources
Intestinal Cystitis Association: www.ichelp.com