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Abstract: Carcinoma in situ is a relatively early cancer pathologically. In this case, the patient presented with intermittent carnal hematuria for 2 months, and the external urological ultrasound indicated fluid in the right renal pelvis, and the perfect examination indicated thickening of the right wall of the bladder, and cancer cells were found in urine exfoliative cytology examination. After the operation, the hematuria disappeared, the drained urine was normal, and the recovery was good.
Basic information】Male, 64 years old
Disease Type】Bladder tumor, hematuria, carcinoma in situ
Hospital】Shijiazhuang People’s Hospital
Date of Consultation】May 2021
Treatment plan】Medication (cefmenoxime hydrochloride for injection) + surgery (transurethral bladder tumor diagnostic electrodesis, laparoscopic radical cystectomy + ileal cystectomy)
Treatment period】Hospitalization for 20 days, outpatient follow-up for 1 month
Treatment effect】hematuria disappeared, drainage of urine was normal, and recovery was good
I. Initial consultation
The patient was forced to come to our urology clinic by his family because of the recent recurrent hematuria, and although he was reluctant, he was more cooperative. No urinary stones were found. Although the patient’s hematuria was significantly reduced after stopping antiplatelet therapy, in order to further clarify the cause of hematuria, we agreed to hospitalization after communicating with the patient and his family.
II. Treatment process
The patient was admitted to hospital because of recurrent carnal hematuria, and cancer cells were found in urinary exfoliation cytology examination, so cystoscopy + bladder mass biopsy was performed under intravenous anesthesia. Although the infiltration of carcinoma in situ was superficial, the tumor differentiation was low and the prognosis was poor. The patient was recommended to undergo BCG bladder perfusion therapy or radical cystectomy + urinary flow diversion therapy. However, the patient considered that he had a history of heart bypass surgery in the past, and his current physical condition was good, but his physical condition might get worse in the future, so the patient and his family were very determined to request surgical treatment. After diagnostic transurethral bladder tumor electrodesis, the diagnosis of bladder carcinoma in situ was clearly made, and the patient was given an aggressive laparoscopic radical cystectomy + ileal cystectomy.
III. Treatment effect
The patient’s postoperative review imaging examination indicated that there was no dilated fluid in the bilateral ureters and the ureteral stent tubes were well positioned. The patient is now very skilled in changing the urine collection bag by himself, and it only takes 5-10 minutes to change it once. Although the postoperative quality of life was affected to a certain extent, the patient did not let the surgery affect his social activities, but could spend more time playing chess with his chess friends for entertainment, unlike having a major surgery.
IV. Notes
We are glad that the patient’s condition has improved after treatment. After discharge, the patient still needs regular follow-up examinations, including blood biochemical examination, urine routine and urine exfoliation cytology examination and chest + abdominal imaging examination, ureteral stent tube removal in 2-4 weeks, regular replacement of urine collection bag, attention to aseptic operation, and moderate drinking water in general. The patient should be rechecked for blood clotting, international normalized ratio (INR), and cardiology or cardiac surgery if necessary. Total cystectomy is a larger surgery, postoperative follow-up should be on time and standardized, so that changes in the condition can be detected and seen in a timely manner. In addition, in life, we need to pay attention to maintaining a good mood, as a good state of mind can alleviate the pain caused by the disease to a certain extent; early to bed and early to rise, combining work and rest, and living a regular life.
V. Personal insight
When recurrent painless carnal hematuria occurs, you must not be careless. Bladder tumor itself its clinical symptoms may be illusory, sometimes good and sometimes bad, which may create the illusion of inflammation, fire, etc. Therefore, it is important to seek medical consultation timely when maladjustment occurs to avoid missing the best time for treatment. In addition, bladder carcinoma in situ is often easy to be missed by imaging examination due to superficial lesions, as in the patient of this case, cancer cells were found only through urinary exfoliative cytology examination, suggesting tumor, therefore, doctors should pay attention to the differentiation, and at present, urinary FISH examination also helps to detect bladder cancer at an early stage clinically, and close follow-up is needed after surgery to give timely treatment with complementary measures when disease progression is detected.