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Abstract: A 75-year-old female patient, who had been treated with surgical resection for bladder occupancy 5 years ago, began to present with terminal hematuria and occasionally complete hematuria with urinary frequency and urgency 1 month ago, and therefore came to our hospital. After examination, the diagnosis of bladder cancer was confirmed and radical cystectomy was performed. After treatment with cefadroxil capsules, levofloxacin tablets, pyrrolizidine hydrochloride for injection and hydroxycamptothecin injection, the symptoms of hematuria disappeared, the frequency and urgency of urination were reduced and the condition was stable.
Basic information】Female, 75 years old
Disease Type】Bladder cancer
Hospital】Central South University Xiangya Hospital
Date of Consultation】June 2022
Treatment plan】Surgical treatment (radical cystectomy) + oral medication (cephalexin capsules, levofloxacin tablets) + intravenous injection (pyridoxine hydrochloride for injection, hydroxycitric acid injection)
[Treatment cycle] Hospitalization for 1 week, review after 1 month, long-term follow-up
Treatment effect】hematuria and urinary frequency symptoms improved, and the condition was stable
I. Initial consultation
One month ago, the patient started to have terminal hematuria and occasionally complete hematuria, accompanied by urinary frequency and urgency. In order to seek further diagnosis and treatment, she came to our outpatient clinic. CT showed that the bladder was full, the wall was not smooth and unevenly thickened, and a slightly dense mass foci were seen on the right side of the bladder, with a few dotted calcification foci on the edge, the size of the larger dimension was about 45×37 mm, and the mass was not clearly demarcated from the adjacent bladder wall. The lesion showed defect-like changes in the detrusor phase. The fatty interstitial space around the bladder was slightly blurred, and there were multiple foci of increased density in the form of cords. Cystoscopy showed that there was a cauliflower-like mass in the triangular area, and the biopsy pathology suggested that there was very little uroepithelial tissue and moderate-to-severe atypical hyperplasia of the uroepithelium. The preliminary diagnosis was bladder cancer, and the patient was admitted to the hospital.
II. Treatment history
After admission, we learned from the patient’s medical history that he had undergone bladder tumor electrosurgery at a local hospital in 2016 due to bladder occupancy. Combining the patient’s medical history and relevant examination results, radical cystectomy was appropriate, and surgical treatment was carried out after communication with the patient. On examination, no tumor was found to invade the urethra, uterus and adnexa, anterior vaginal wall, pelvic peritoneum and other adjacent tissues and organs, so it was not treated. The patient’s bladder was completely removed and pelvic lymphadenectomy was performed at the same time. To ensure that the patient could resume normal urinary function after the operation, a new urinary storage bag was established to replace the bladder’s function of storing urine, and the operation proceeded smoothly. The patient was treated with injectable piroplatin hydrochloride and hydroxycamptothecin injection for 4 weeks to inhibit the growth of tumor cells.
III. Treatment effect
Before admission, the patient presented with terminal hematuria and occasionally complete hematuria with urinary frequency and urgency, and a cauliflower-like mass was seen on imaging. After radical cystectomy, no complications occurred. After 1 week, the patient recovered well from the incision, the hematuria disappeared, and the symptoms of urinary frequency and urgency were relieved, and was discharged from the hospital. The patient was instructed to insist on re-examination once every 3 months and to seek medical attention if there was any discomfort during the period.
IV. Notes
After the patient’s condition was stabilized, I felt very happy too. On the occasion of discharge from the hospital, I did not forget to emphasize to the patient that the following points should be noted in life.
1, it is advisable to eat more fresh vegetables and fruits, as well as fish, eggs, milk and other foods rich in high-quality protein, and avoid the intake of high-salt, high-fat, spicy and stimulating foods.
2, to develop good habits, quit smoking and drinking, early to bed and early to rise, avoid overwork, stay up late.
3, patients can be appropriate exercise, it is recommended to choose walking, tai chi and other low-intensity exercise, exercise to avoid sports injuries.
4, daily attention to hydration, can play a role in flushing the urinary bladder to reduce the risk of infection.
V. Personal insight
The recurrence and metastasis rates of bladder cancer are high. Early detection and treatment can reduce the risk of the disease to a certain extent, increase the survival rate of patients and improve the quality of life. The typical symptom in the early stage of the disease is hematuria, which is intermittent at the beginning and may appear as a continuous hematuria with the development of the disease. Therefore, once hematuria is detected, it should be taken seriously, and the patient should be seen by a hospital in time to determine the cause and then treated actively. For example, in this case, the patient was seen in a timely manner, and the deterioration of the disease was stopped without serious consequences.