Urothelial bladder carcinoma with major clinical presentation as overactive bladder, without hematuria: case report and literature review


  • Alexander de J. Rafaelano M. Gynecology and Obstetrics Resident at the Postgraduate School of Naval Sanity, Universidad Naval and the Hospital General Naval de Alta Especialidad, Secretaría de Marina Armada de México (SEMAR)
  • Junior J. Araiza Navarro Gynecology and Obstetrics Resident at the Postgraduate School of Naval Sanity, Universidad Naval and the Hospital General Naval de Alta Especialidad, Secretaría de Marina Armada de México (SEMAR)
  • María Isabel Tolentino Sosa Gynecologist-Obstetrician, Gynecological Urology, Chief of the Urogynecology Service of the Hospital General Naval de Alta Especialidad, Secretaría de Marina Armada de México (SEMAR)
  • Fernando López Reyes Urologist, Kidney Transplant Specialist, of the Hospital General Naval de Alta Especialidad, Secretaría de Marina Armada de México (SEMAR)
  • Marlene de la Peña Gutiérrez Gynecologist-Obstetrician, Specialist in Maternal-Fetal Medicine, Hospital General Naval de Alta Especialidad, Secretaría de Marina Armada de México (SEMAR)




Hematuria, Overactive bladder, Urinary Bladder Cancer


The urothelial carcinoma is the most common type of bladder cancer, comprising approximately 90% of cases in the United States. The most common symptom of bladder cancer is macroscopic hematuria, increased urinary frequency, urgency, or irritative symptoms may occur. Generally, occurs in elderly people, about 9 out of 10 people are over 55 years old, with the average age at diagnosis of 73 years. Males are more likely than women to have this neoplasm with a probability of 1 in 27 (for women the probability is 1 in 89). Most bladder cancers begin in the inner layer, also called the urothelium or transitional epithelium. As it advances, it invades the layers of the bladder and can invade adjacent structures, often metastasizing to distant lymph nodes, bones, lungs or the liver. Among the cancers that originate in the bladder authors have: Urothelial carcinoma (transitional cell carcinoma), squamous cell carcinoma, adenocarcinoma, small cell carcinoma, sarcoma. Hematuria occurs in the majority of patients with urothelial carcinoma. Symptoms such as dysuria, frequency, urgency and pain may also occur, or it may also be asymptomatic.  In this case report, an atypical presentation of bladder cancer is shown, simulating the symptomatology of a Hyperactive Bladder Syndrome.


Xie D, Zhang H, Shang C. Long non-coding RNA CDKN2B antisense RNA 1 gene inhibits Gemcitabine sensitivity in bladder urothelial carcinoma. J Cancer. 2018;9(12):2160-6.

National Cancer Institute Cancer of the urinary bladder. 2016. Available at: http://seer.cancer.gov/statfacts/html/urinb.html.

IARC Working Group on the Evaluation of Carcinogenic Risks to Humans, World Health Organization, International Agency for Research on Cancer. Tobacco smoke and involuntary smoking. IARC. 2004.

Pashos CL, Botteman MF, Laskin BL, Redaelli A. Bladder cancer: epidemiology, diagnosis, and management. Cancer Pract. 2002;10(6):311-22.

Li N, Yang L, Zhang Y, Zhao P, Zheng T, Dai M. Human papillomavirus infection and bladder cancer risk: a meta-analysis. J Infect Dis. 2011;204(2):217-23.

Kleinerman RA, Boice Jr JD, Storm HH, Sparen P, Andersen A, Pukkala E, et al. Second primary cancer after treatment for cervical cancer. An Int Cancer Registries Study. Cancer. 1995;76(3):442-52.

Travis LB, Curtis RE, Fraumeni Jr JF, Boice Jr JD, Storm H, Andersson M, et al. Risk of second malignant neoplasms among long-term survivors of testicular cancer. J Nat Cancer Institute. 1997;89(19):1429-39.

Sandhu JS, Vickers AJ, Bochner B, Donat SM, Herr HW, Dalbagni G. Clinical characteristics of bladder cancer in patients previously treated with radiation for prostate cancer. BJU Int. 2006;98(1):59-62.

Bostrom PJ, Soloway MS, Manoharan M, Ayyathurai R, Samavedi S. Bladder cancer after radiotherapy for prostate cancer: detailed analysis of pathological features and outcome after radical cystectomy. J Urol. 2008;179(1):91-5.

Shah SK, Lui PD, Baldwin DD, Ruckle HC. Urothelial carcinoma after external beam radiation therapy for prostate cancer. J Urol. 2006;175:2063.

Yee DS, Shariat SF, Lowrance WT, Sterbis JR, Vora KC, Bochner BH, et al. Impact of previous radiotherapy for prostate cancer on clinical outcomes of patients with bladder cancer. J Urol. 2010;183(5):1751-6.

Keehn A, Ludmir E, Taylor J, Rabbani F. Incidence of bladder cancer after radiation for prostate cancer as a function of time and radiation modality. World J Urol. 2017;35:713.

13.- Hinotsu S, Akaza H, Miki T, et al. Bladder cancer develops 6 years earlier in current smokers: analysis of bladder cancer registry data collected by the cancer registration committee of the Japanese Urological Association. Int J Urol 2009; 16:64.

Harshman LC, Preston MA, Bellmunt J, Beard C. Diagnosis of bladder carcinoma: a clinician’s perspective. Surg Pathol Clinics. 2015;8(4):677-85.

Mayorga GE, Ibarra OI, Sedano BJ, Trujillo OL, Cornejo DV, Palmeros RA, et al. Application of nomograms in Mexico for bladder cancer in patients of the General Hospital "Dr. Manuel Gea González ". Mexican J Urol. 2014;74(1):3-8.

Sun M, Trinh QD. Diagnosis and staging of bladder cancer. Hematol/ Oncol Clinics. 2015;29(2):205-18.

Gormley EA, Lightner DJ, Faraday M, Vasavada SP. Diagnosis and treatment of overactive bladder (non-neurogenic) in adults: AUA/SUFU guideline amendment. J Urol. 2015;193(5):1572-80.

Telli O, Sarici H, Ozgur BC, Doluoglu OG, Sunay MM, Bozkurt S, et al. Urothelial cancer of bladder in young versus older adults: clinical and pathological characteristics and outcomes. Kaohsiung J Med Sci. 2014;30(9):466-70.

White N, Iglesia CB. Overactive bladder. Obstet Gynecol Clin N Am. 2016;43(1):59-68.

Cidre MJ, López-Fando L, Esteban M, Franco A, Arlandis S, Castro D, et al. How should we address the diagnosis of overactive bladder in women?. Spanish Urological Records. 2016;40(1):29-36.

Aw HC, Ranasinghe W, Tan PH, O’Connell HE. Overactive pelvic floor muscles (OPFM): improving diagnostic accuracy with clinical examination and functional studies. Translational Androl Urol. 2017;6(Suppl 2):S64.

Ngo B, Perera M, Papa N, Bolton D, Sengupta S. Factors affecting the timeliness and adequacy of haematuria assessment in bladder cancer: a systematic review. BJU Int. 2017;119:10-8.

Niemi MA, Cohen RA. Evaluation of microscopic hematuria: a critical review and proposed algorithm. Adv Chronic Kidney Dis. 2015;22(4):289-96.

Atta MA, Kotb AF, Sharafeldeen M, Elabbady A, Hashad MM. The value of extended good quality transurethral resection of bladder tumour in the treatment of the newly diagnosed bladder cancer. Arab J Urol. 2017;15(1):60-3.






Case Reports