Introduction

The diagnosis of bladder cancer is histopathological and biopsy material is readily obtained at cystoscopy. Imaging does, however, have a number of roles complementing cystoscopy in evaluating the bladder for the detection and characterization of any bladder lesion and also in evaluating the upper tracts. In this chapter we review imaging techniques and the role of imaging in the diagnosis of bladder cancer.

Clinical presentation and management

Bladder cancer may be diagnosed in a variety of clinical scenarios. The commonest presenting symptom is painless macroscopic hematuria. Lower urinary tract symptoms such as dysuria, urgency or frequency are also common. Occasionally, the diagnosis may be made incidentally on imaging for an unrelated problem or it may be that metastatic disease (see Chapter 5) precipitates the initial clinical presentation of bladder cancer, e.g., cachexia or pain from bone metastasis, but this is very unusual.

Hematuria

Hematuria is a common urological symptom with a wide range of causes from pre-renal disorders such as coagulation dysfunction to renal and bladder causes. Painless macroscopic hematuria should be assumed to be secondary to a bladder tumor unless proven otherwise as over 80% of patients with bladder cancer present in this way [1]. Between the ages of 40 and 49 years, 16% of men with macroscopic hematuria have a urological cancer and in men between 50 and 59 years of age, 20% [2].