Purpose:Cxbladder tests are urinary biomarker tests for detection of urothelial carcinoma. We developed enhanced Cxbladder tests that incorporate DNA analysis of 6 single nucleotide polymorphisms for the FGFR3 and TERT genes, in addition to the current 5 mRNA biomarkers and clinical risk factors.Materials and Methods:Two multicenter, prospective studies were undertaken in: (1) U.S. patients with gross hematuria aged ≥18 years and (2) Singaporean patients with gross hematuria or microhematuria aged >21 years. All patients provided a midstream urine sample and underwent cystoscopy. Samples were retrospectively analyzed using enhanced Cxbladder-Triage (risk stratifies patients), enhanced Cxbladder-Detect (risk stratifies patients and detects positive patients), and the combination enhanced Cxbladder-Triage × Cxbladder-Detect.Results:In the pooled cohort (N=804; gross hematuria: n=484, microhematuria: n=320), enhanced Cxbladder-Detect had a sensitivity of 97% (95% CI 89%-100%), specificity of 90% (95% CI 88%-92%), and negative predictive value of 99.7% (95% CI 99%-100%) for detection of urothelial carcinoma. Overall, 83% of patients were enhanced Cxbladder-Detect–negative (ie, needed no further work-up). Of 133 enhanced Cxbladder-Detect–positive patients, 59 had a confirmed tumor, of which 19 were low-grade noninvasive papillary carcinoma or papillary urothelial neoplasm of low malignant potential. In total, 40 tumors were high-grade Ta, T1-T4, Tis, including concomitant carcinoma in situ. Of the 74 patients with normal cystoscopy, 41 were positive by single nucleotide polymorphism analysis. Enhanced Cxbladder-Triage and enhanced Cxbladder-Detect had significantly better specificity than the first-generation Cxbladder tests (P < .001).Conclusions:This study in ethnically diverse patients with hematuria showed the analytical validity of the enhanced Cxbladder tests.

Urinary stones of up to 5 mm of diameter are known to pass spontaneously through the urinary tract; whereas those exceeding 7 mm of diameter almost always require surgical intervention. To the best of our knowledge, the option of expectant management for large stones is rarely considered. We report an unusual case of a woman who spontaneously passed out two large bladder stones measuring 70 and 60 mm without having significant pain or bleeding. We find this case striking for the fact that giant bladder stones can expel spontaneously without any surgical manipulations.

Immune (idiopathic) thrombocytopenic purpura (ITP) is an uncommon, but important cause of thrombocytopenia in pregnancy. It is a diagnosis of exclusion, and management should be based on a multidisciplinary care approach. ITP is characterized by moderate-to-severe thrombocytopenia commonly diagnosed in the first or early second trimester of pregnancy. The severity of thrombocytopenia has adverse implications on both maternal and fetal well-being. This paper is based on a case seen and managed in our institution and aims to discuss the various causes of thrombocytopenia and its implications in pregnancy as well as management of ITP in pregnancy based on current evidence and guidelines.

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