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Abstract: Patient Lao Zhang, 43 years old, came to the hospital for help after reporting sudden abdominal pain and painful urination with hematuria 1 week ago, which could not be relieved even after 1 week. After systematic examination and combined with the patient’s uncomfortable symptomatic manifestations, he was finally diagnosed with adenocarcinoma of the bladder. The patient was also treated with aggressive surgery and medication. The patient’s condition was controlled and the symptoms of abdominal pain, painful urination and hematuria disappeared.
Basic information】Male, 43 years old
Type of disease】Cancer of the bladder
Hospital】The First Affiliated Hospital of Zhejiang University School of Medicine
Date of consultation】July 2021
Treatment plan】Surgery (total cystectomy with pelvic lymph node dissection) + oral medication (amoxicillin capsule) + intravenous medication (levofloxacin injection, injectable gemcitabine hydrochloride, cisplatin injection)
Treatment period】7 days of in-hospital treatment, half a month of outpatient follow-up after discharge
Treatment effect】The condition has been controlled, and the symptoms of abdominal pain, painful urination and hematuria have disappeared.
I. Initial consultation
Patient Zhang, 43 years old, complained of abdominal pain and painful urination with hematuria for unknown reasons 1 week ago, and did not see any trend of reduction after rest, so he came to our hospital. After listening to the patient’s description, he was given a CT examination, which showed an irregular nodular shadow in the bladder wall. After further improvement of cystoscopy, the results showed an inwardly projecting mass in the bladder wall with an irregular shape and the base attached to the anterior wall of the bladder. Combining the patient’s discomfort, laboratory findings, and biopsy results, the patient was diagnosed with adenocarcinoma of the bladder.
II. Treatment history
The patient was informed that his abdominal pain, urinary pain and hematuria were caused by adenocarcinoma of the bladder and that he should be treated with surgery and medication in time to prevent the cancer from spreading and endangering his health and life. Before surgery, the patient’s skin was cleaned and shaved, and after routine skin disinfection and anesthesia, a total cystectomy with pelvic lymph node dissection was performed. A laparoscopic channel was established in the umbilicus and the right and left lower abdomen, and the bladder was cut off from the urethral junction and removed, followed by pelvic lymph node dissection, including internal, external and closed lymph nodes. The patient was returned to the ward after awakening, and was given amoxicillin capsule and levofloxacin injection for anti-infection treatment and gemcitabine hydrochloride for injection and cisplatin injection for postoperative chemotherapy.
III. Treatment effect
On the 1st day after surgery, the patient’s body temperature was 36.7℃. Upon examination, no flow of pus was found at the postoperative incision, and the diet and diarrhea were normal, indicating that the surgery went smoothly. On the 3rd day after surgery, the color of the patient’s urine became lighter, the symptoms of painful urination and abdominal pain subsided, and the self-reported discomfort in the body was not very strong and could be tolerated. On the 7th day after surgery, the condition had been controlled, and the symptoms of abdominal pain, urinary pain and hematuria disappeared. After rechecking CT and cystoscopy, the results showed no abnormality, and no irregular nodular shadow at the bladder or masses raised on the surface were found, and the patient was discharged normally. The patient was discharged normally. Half a month after discharge, he was reexamined at the outpatient clinic and no recurrence was observed.
IV. Notes
I was very pleased to see the patient discharged happily. When I discharged the patient, I told him that he should pay attention to his diet at home and try to avoid spicy and stimulating foods such as beer, chili, strong coffee, etc. He could eat more high-protein and high-vitamin foods such as eggs, fish, bananas, apples, dragon fruit, cucumbers, etc. He should also pay attention to keeping his mood happy. In addition, patients can also exercise properly, such as walking slowly, playing Tai Chi, etc. Do not do too strenuous or excessive amplitude of exercise to prevent the surgical incision tears. In addition, I also repeatedly advised the patient to take the medications prescribed by me at the time of discharge on time and in accordance with the dosage, and to seek medical advice at any time if there was any discomfort.
V. Personal insight
In clinical practice, patients with bladder cancer usually have a poor prognosis, but fortunately, in this case, the patient sought medical help in time after he found abnormal discomfort and did not take any medication on his own, and after surgery and medication, the patient’s condition was controlled and the final treatment result was satisfactory. This tells us that if we find abnormal symptoms in our life, we should seek medical help in time to avoid misdiagnosis or delayed treatment. After professional diagnosis and treatment, it can help to reduce the discomfort symptoms and promote the healing of the disease as soon as possible.