Accuracy of Preoperative Urinary Symptoms, Urinalysis, Computed Tomography and Cystoscopic Findings for the Diagnosis of Urinary Bladder Invasion in Patients with Colorectal Cancer

  • Woranisarakul, Varat (Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University) ;
  • Ramart, Patkawat (Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University) ;
  • Phinthusophon, Kittipong (Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University) ;
  • Chotikawanich, Ekkarin (Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University) ;
  • Prapasrivorakul, Siriluck (Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University) ;
  • Lohsiriwat, Varut (Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University)
  • Published : 2014.09.15


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. Materials and 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.


  1. Chaleoykitti B (2005). Preoperative diagnosis of urinary bladder involvement in adenocarcinoma of colon and rectum. J Med Assoc Thai, 88, 1816-20.
  2. Chuttiangtum A, Udomthavornsuk B, Chumworathayi B (2012). Hematuria screening test for urinary bladder mucosal infiltration in cervical cancer. Asian Pac J Cancer Prev, 13, 4931-3.
  3. Garcea G, Majid I, Sutton CD, Pattenden CJ, Thomas WM (2006). Diagnosis and management of colovesical fistulae; six-year experience of 90 consecutive cases. Colorectal Dis, 8, 347-52.
  4. Ghafouri-Fard S, Nekoohesh L, Motevaseli E (2014). Bladder cancer biomarkers: review and update. Asian Pac J Cancer Prev, 15, 2395-403.
  5. Heo SH, Kim JW, Shin SS, Jeong YY, Kang HK (2014). Multimodal imaging evaluation in staging of rectal cancer. World J Gastroenterol, 20, 4244-55.
  6. Kim KH (2013). More than the significance of conventional urinalysis. Int Neurourol J, 17, 153-4.
  7. Kim SH, Na DG, Choi BI, Han JK, Han MC (1992). Direct invasion of urinary bladder from sigmoid colon cancer: CT findings. J Comput Assist Tomogr, 16, 709-12.
  8. Kobayashi T, Kamoto T, Sugino Y, et al (2003). High incidence of urinary bladder involvement in carcinomas of the sigmoid and rectum: a retrospective review of 580 patients with colorectal carcinoma. J Surg Oncol, 84, 209-14.
  9. Lohsiriwat V, Lohsiriwat D (2008). Comparison of immediate surgical outcomes between posterior pelvic exenteration and standard resection for primary rectal cancer: a matched casecontrol study. World J Gastroenterol, 14, 2414-7.
  10. Lohsiriwat V, Pongsanguansuk W, Lertakyamanee N, Lohsiriwat D (2010). Impact of metabolic syndrome on the short-term outcomes of colorectal cancer surgery. Dis Colon Rectum, 53, 186-91.
  11. Luo HL, Tsai KL, Lin SE, Chiang PH (2013). Outcome of urinary bladder recurrence after partial cystectomy for en bloc urinary bladder adherent colorectal cancer resection. Int J Colorectal Dis, 28, 631-5.
  12. McNamara DA, Fitzpatrick JM, O'Connell PR (2003). Urinary tract involvement by colorectal cancer. Dis Colon Rectum, 46, 1266-76.
  13. Mohan HM, Evans MD, Larkin JO, Beynon J, Winter DC (2013). Multivisceral resection in colorectal cancer: a systematic review. Ann Surg Oncol, 20, 2929-36.
  14. Park S, Lee YS (2011). Analysis of the prognostic effectiveness of a multivisceral resection for locally advanced colorectal cancer. J Korean Soc Coloproctol, 27, 21-6.
  15. Pollard SG, Macfarlane R, Greatorex R, Everett WG, Hartfall WG (1987). Colovesical fistula. Ann R Coll Surg Engl, 69, 163-5.
  16. Pourhoseingholi MA (2012). Increased burden of colorectal cancer in Asia. World J Gastrointest Oncol, 4, 68-70.
  17. Smith D, Ballal M, Hodder R, et al (2006). Symptomatic presentation of early colorectal cancer. Ann R Coll Surg Engl, 88, 185-90.
  18. Talamonti MS, Shumate CR, Carlson GW, Curley SA (1993). Locally advanced carcinoma of the colon and rectum involving the urinary bladder. Surg Gynecol Obstet, 177, 481-7.
  19. Unal HU, Demiralay E, Tepeoglu M, Fidan C, Kilickap S (2013). Lack of relationships between FGF19 staining pattern, lymph node metastasis and locally invasive characteristics of the tumor in colorectal cancers. Asian Pac J Cancer Prev, 14, 3151-4.
  20. van de Velde CJ, Boelens PG, Tanis PJ, et al (2014). Experts reviews of the multidisciplinary consensus conference colon and rectal cancer 2012: science, opinions and experiences from the experts of surgery. Eur J Surg Oncol, 40, 454-68.
  21. Wu HW, Gao LD, Wei GH (2013). hMSH2 and nm23 expression in sporadic colorectal cancer and its clinical significance. Asian Pac J Cancer Prev, 14, 1995-8.

Cited by

  1. Diagnostic accuracy of cystoscopy and ultrasonography in the prenatal diagnosis of abnormally invasive placenta vol.97, pp.15, 2018,