Mrs. A.B., 73 years of age consulted me with history of total painless hematuria 15 days back. This was accompanied by pain in the left lumbar region. The episode lasted for 2 days. She also suffers from diabetes mellitus and hypertension for last 10 years. She underwent Coronary Angiography for Ischemic heart disease and has been on medication since then. She underwent Cystoscopy and biopsy of bladder tumor outside which revealed low grade transitional cell Carcinoma.
Physical Examination was essentially normal. The CT scan revealed a lobulated hypodense 3.8 X 3.5 cms sized mildly enhancing soft tissue mass lesion in the right postero-lateral aspect of Urinary Bladder. This is involving the right vesico-ureteric junction. A streaking of perivesical fat is noted. The urinary bladder otherwise shows normal distension and wall thickness.
She was advised to undergo Cystoscopy and Trans Urethral Resection of Bladder Tumor (TURBT) for which she was admitted to the hospital. She underwent Trans Urethral Resection of Bladder Tumor (TURBT). At Cystoscopy she had a papillary tumor arising just beyond the right ureteric. The right ureteric orifice could not be seen. Right ureteric orifice however, was successfully catheterized using number 5 ureteric catheter. There was no intra luminal lesion in the right ureteric orifice and the papillary growth of the bladder was resected saving the right ureteric orifice. The mass was completely resected and the histopathology revealed Papillary Urothelial Carcinoma (Grade III) of the Urinary Bladder.
Mrs. A.B. was discharged from the hospital in satisfactory condition. Post operative day she passed urine satisfactorily. She has been advised for a follow up after 10 days with urine analysis and she is doing well. She is also advised to come back for check Cystoscopy after 3 months.Mrs. A.B is now fit to resume her normal activities.
Dr. Dilip Raja
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