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Abstract: A 64-year-old man, Mr. Xu, had recurrent painless complete carnal hematuria for six months. A malignant bladder tumor was considered after urological ultrasound and cystoscopy, and the postoperative pathology confirmed the diagnosis of low-grade noninvasive uroepithelial carcinoma. The patient was treated with transurethral bladder tumor enucleation. After the operation, the patient was given bladder infusion chemotherapy, and the patient’s hematuria disappeared, and the review showed no recurrence of tumor and good physical recovery.
Basic information】Male, 64 years old
Disease Type】Low-grade non-invasive uroepithelial carcinoma
Hospital】The First Affiliated Hospital of Zhejiang University School of Medicine
Date of consultation】September 2020
Treatment plan】Surgical treatment (transurethral bladder tumor enucleation) + bladder perfusion chemotherapy
Treatment period】3 days in hospital, lifelong follow-up in outpatient clinic
Treatment effect】hematuria disappeared, no recurrence of tumor, good physical recovery
I. Initial consultation
The patient reported that he started to have hematuria about six months ago, and all of his urine was red without blood clots, no urinary frequency and urgency, and no painful urination. He was diagnosed with “urinary tract infection” at the local hospital, and the hematuria disappeared after the use of intravenous antibacterial drugs. This time, hematuria appeared again, and he came to our hospital. Routine urinalysis showed a significant increase in red blood cells, and urological ultrasonography revealed a neoplasm in the bladder near the end of the right ureter, and perfect cystoscopy showed a papillary neoplasm above the right ureteral orifice.
II. Treatment process
After learning that it was a malignant tumor, the patient was depressed. After detailed communication with the patient, the patient expressed his willingness to actively cooperate with the doctor for treatment, so the patient was admitted to the hospital. After the preoperative examination, there was no contraindication to surgery, so the surgery was performed the next day. The patient underwent a transurethral bladder tumor enucleation under general anesthesia. Postoperatively, the patient underwent continuous bladder irrigation to prevent blockage of the catheter by blood clots. The postoperative pathology report suggested low-grade noninvasive uroepithelial carcinoma; therefore, the patient was finally diagnosed with low-grade noninvasive uroepithelial carcinoma. The patient received six postoperative bladder instillation chemotherapy sessions with the aim of preventing tumor recurrence.
III. Treatment outcome
After performing surgical treatment, the patient’s lesion was removed, her psychological status improved, she recovered well, and she was discharged from the hospital 3 days after surgery. The patient was reexamined 3 months after surgery, and there was no hematuria and good recovery of the surgical wound. The patient reported good physical condition and did not feel any physical abnormality, and the examination results showed no tumor recurrence. The patient was instructed to review every 3 months for 2 years after surgery, every 6 months for 2-5 years after surgery, and once a year after 5 years after surgery, including cystoscopy and urological ultrasound. In addition, patients need to have annual health checkups.
IV. Precautions
We are glad that the patient is cured of the disease and is in good health after the surgery. After the operation, we need to pay attention to diet regulation, mainly fresh and healthy food, and we should eat less or no fresh food such as pickled food, waxed food and smoked food. Usually pay attention to drink more water and carefully observe the color change of urine when urinating, whether hematuria appears, if it does, the possibility of disease recurrence needs to be considered and should be seen in hospital in time. At the same time, patients need to pay attention to personal hygiene, they can wash their vulva with flowing water every day to keep it clean and dry to avoid infection.
V. Personal perception
Bladder tumor is a common tumor of urinary system, the most important manifestation of which is painless whole meatus hematuria, so those who have this symptom need to be alert to the possibility of bladder tumor. The hematuria of bladder tumor can be intermittent, which will give patients the illusion of getting better and requires vigilance. If patients have frequent hematuria, besides routine urinalysis and urinary ultrasound examination, they are also recommended to have a cystoscopy, which should not be a hassle and must be clearly diagnosed.