[Clinical diagnosis of bladder cancer]

The minimum requirements of the International Union against Cancer (UICC) to assess the TNM-classification of urothelial bladder cancer include since 1978 the clinical examination, urography, cystoscopy, bimanual palpation under anesthesia and biopsy or transurethral resection of the tumor. The single biopsy of the tumor should be supplemented by multiple biopsies of all bladder walls in combination with the resection of the tumor to diagnose multifocal tumor growth. The exfoliative urinary cytology should be included in the routine diagnostic regimen: cytology is helpful in detection of severe dysplasia and controls the histologically determined grade of the tumor. In selected cases computer tomography improves the accuracy of clinical evaluation of the depth of tumor infiltration. In our hands the lymphangiography can not assess the regional lymph node metastases: therefore, the staging operation is recommended before radical cystectomy is performed.