Comparative evaluation of nonesterified and total urinary cholesterol in papilloma and carcinoma of the bladder

Urinary excretion of nonesterified (NEC) and total cholesterol (TC)
has been determined in 137 healthy individuals with a range (2 SD)
of 0.26-2.2 mg/24 hours NEC and 0.3-3.0 mg/24 hours TC. 264
patients with various internal diseases revealed normal values of
NEC and TC; neoplasias, diseases of the kidney and prostatic
adenoma with residual urine had been excluded with reasonable
certainty. There was no correlation between urinary cholesterol
excretion and cholesterol plasma levels. In papilloma of the
bladder (n = 16) NEC hyperexcretion was present in 56%; elevated
levels of TC were determined in 68%. In carcinoma of the bladder,
T1N0M0-T2N0M0 (n = 28), hyperexcretion of NEC occurred in 50% and
of TC in 64%. In advanced clinical stages of the disease,
T3N0M0-T4N4M1d (n = 21), elevated values of NEC were detected in
76% and of TC in 90%. Since all macroscopically blood contaminated
urinary samples had been excluded, a determination of total urinary
cholesterol excretion may be valuable in the diagnosis of papilloma
or carcinoma of the bladder in the absence of macrohematuria.
Occult blood in urine was present in 33 of the 65 patients with
papilloma or carcinoma of the bladder, which was associated in 26
cases with elevated urinary total cholesterol. 32 patients revealed
a negative test for occult blood in urine. In 22 of these,
hyperexcretion of urinary total cholesterol was observed,
indicating diagnostic sensitivity of this parameter for papilloma
and carcinoma of the bladder even in the absence of microhematuria.
However, one has to regard that elevated urinary cholesterol levels
could also occur in other carcinomas of the urogenital system,
prostatic adenoma with residual urine and kidney diseases.