Smoking is a risk factor for developing squamous cell carcinoma of the bladder. The bladder can be exposed to very high concentrations of toxins from cigarette smoke once the toxins are excreted via the urinary tract. These toxins, such as polycyclic aromatic hydrocarbons, disrupt DNA and lead to dysplasia.
Chronic cystitis is a painful bladder condition that includes symptoms such as pelvic pain or pressure and a frequent urge to urinate. Most of the time, the inflammation is caused by a bacterial infection like E. coli but may also include irritation from urinary catheters, certain medications like cyclophosphamide, or radiation therapy. Chronic irritation leads to metaplasia and later dysplasia.
In areas where schistosomiasis is endemic, there is a high incidence of squamous cell carcinoma of the bladder. Schistosoma haematobium is a species of digenetic trematode, belonging to blood flukes. It is commonly found in Sub-Saharan Africa and the Middle East. Schistosoma haematobium invades the venous plexus around the urinary bladder and the eggs are released by the adult worm which causes chronic granulomatous inflammation in the mucosal and submucosal layers of the bladder.
Chronic nephrolithiasis (kidney stones) is more common in young and middle-aged adults. Certain medical conditions increase the risk of nephrolithiasis which include primary hyperparathyroidism, obesity, diabetes, and gout. Recurring kidney stone formation is associated with the irritation of the bladder wall which can lead to dysplasia of the transitional cells.
Painless hematuria is seen in patients with squamous cell carcinoma of the bladder. Be aware that transitional cell carcinoma will also present with painless hematuria. There are no casts seen in the bladder.
Patients may complain of urinary frequency and urgency. Urinary frequency is distinguished from polyuria, which is urine output of >3 L/day. Urinary urgency is the sudden need to urinate.
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