title: Accuracy of preoperative urinary symptoms, urinalysis, computed tomography and cystoscopic findings for the diagnosis of urinary bladder invasion in patients with colorectal cancer.
abstract: BACKGROUND
  To determine the accuracy of preoperative urinary symptoms, urinalysis, computed tomography (CT) and cystoscopic findings for the diagnosis of urinary bladder invasion in patients with colorectal cancer.
  
  
  METHODS
  Records of patients with colorectal cancer and a suspicion of bladder invasion, who underwent tumor resection with partial or total cystectomy between 2002 and 2013 at the Faculty of Medicine Siriraj Hospital, were reviewed. Correlations between preoperative urinary symptoms, urinalysis, cystoscopic finding, CT imaging and final pathological reports were analyzed.
  
  
  RESULTS
  This study included 90 eligible cases (71% male). The most common site of primary colorectal cancer was the sigmoid colon (44%), followed by the rectum (33%). Final pathological reports showed definite bladder invasion in 53 cases (59%). Significant features for predicting definite tumor invasion were gross hematuria (OR 13.6, sensitivity 39%, specificity 73%), and visible tumor during cystoscopy (OR 5.33, sensitivity 50%, specificity 84%). Predictive signs in CT imaging were gross tumor invasion (OR 7.07, sensitivity 89%, specificity 46%), abnormal enhancing mass at bladder wall (OR 4.09, sensitivity 68%, specificity 66%), irregular bladder mucosa (OR 3.53, sensitivity 70%, specificity 60% ), and loss of perivesical fat plane (OR 3.17, sensitivity 81%, specificity 43%). However, urinary analysis and other urinary tract symptoms were poor predictors of bladder involvement.
  
  
  CONCLUSIONS
  The present study demonstrated that the most relevant preoperative predictors of definite bladder invasion in patients with colorectal cancer are gross hematuria, a visible tumor during cystoscopy, and abnormal CT findings.
authors.affiliation: Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand E-mail : bolloon@hotmail.com.
authors.forename: Varat
authors.initials: V
authors.lastname: Woranisarakul
authors.forename: Patkawat
authors.initials: P
authors.lastname: Ramart
authors.forename: Kittipong
authors.initials: K
authors.lastname: Phinthusophon
authors.forename: Ekkarin
authors.initials: E
authors.lastname: Chotikawanich
authors.forename: Siriluck
authors.initials: S
authors.lastname: Prapasrivorakul
authors.forename: Varut
authors.initials: V
authors.lastname: Lohsiriwat
mesh_terms: D000230:Adenocarcinoma / Q000150:complications / Q000473:pathology* / Q000601:surgery; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015179:Colorectal Neoplasms / Q000150:complications / Q000473:pathology* / Q000601:surgery; D003558:Cystoscopy; D005260:Female; D006417:Hematuria / Q000209:etiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D057234:Preoperative Period; D012004:Rectal Neoplasms / Q000150:complications / Q000473:pathology / Q000601:surgery; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D012811:Sigmoid Neoplasms / Q000150:complications / Q000473:pathology / Q000601:surgery; D014057:Tomography, X-Ray Computed; D016482:Urinalysis; D001743:Urinary Bladder / Q000000981:diagnostic imaging / Q000473:pathology* / Q000601:surgery; D001749:Urinary Bladder Neoplasms / Q000175:diagnosis*