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Hematuria in a 90-Year-Old Male Leading to the Diagnosis of Bladder Tumor

Hematuria in a 90-Year-Old Male Leading to the Diagnosis of Bladder Tumor

Hematuria in a 90-Year-Old Male Leading to the Diagnosis of Bladder Tumor: Hematuria is a common symptom that warrants thorough investigation due to its association with various urological conditions. This case report describes the clinical presentation, diagnostic approach, and initial management of a 90-year-old male presenting with hematuria, ultimately leading to the diagnosis of a bladder tumor.

Hematuria in a 90-Year-Old Male Leading to the Diagnosis of Bladder Tumor

Patient Presentation

A 90-year-old male presented to the Institute of Urology, Jaipur, with complaints of visible blood in his urine. The patient was a known case of hypertension (HTN) and benign prostatic hyperplasia (BPH) and had been on a long-term indwelling catheter for the past five years due to chronic urinary retention.

Diagnostic Workup

  • X-ray KUB: Revealed no evidence of calculi.
  • Ultrasound (USG): Detected a mildly vascular, lobulated lesion along the lateral wall of the urinary bladder. The findings also included clots and debris within the bladder.
  • Prostate Findings: The prostate gland was significantly enlarged, with an estimated weight of over 65 grams, consistent with the patient’s history of BPH.

Management and Procedure

Under the expert guidance of Dr. M. Roychowdhury and Dr. Rajan Bansal, a comprehensive approach was taken to address the patient’s symptoms and evaluate the suspected bladder lesion:

  1. Cystoscopy:
    • A cystoscopic examination was performed, revealing a vascular and lobulated lesion on the lateral bladder wall.
    • Clots and debris were evacuated to ensure clear visualization.
  2. Transurethral Resection of Bladder Tumor (TURBT):
    • The lesion was resected endoscopically.
    • Care was taken to ensure complete removal of visible tumor tissue.
  3. Deep Muscle Biopsy:
    • A deep muscle biopsy was obtained to assess the depth of invasion and confirm the pathological diagnosis.

Outcome and Follow-Up

The patient tolerated the procedure well and was discharged in stable condition. The biopsy results are pending, and further management will be tailored based on the histopathological findings. This will involve a multidisciplinary discussion with the patient and his family to outline potential treatment options, which may include:

  • Intravesical therapy (e.g., Bacillus Calmette-Guerin for superficial tumors).
  • Radical surgery or systemic therapy for invasive or advanced disease.

Discussion

This case underscores the importance of addressing hematuria, especially in elderly patients with comorbidities such as BPH and prolonged catheterization, which are risk factors for bladder pathologies. Early detection and timely intervention are crucial for optimal outcomes.

Bladder cancer often presents with subtle symptoms like hematuria that may be overlooked, especially in elderly individuals with preexisting conditions. Diagnostic tools such as cystoscopy and imaging play a pivotal role in identifying and staging bladder tumors.

Conclusion

This case highlights the need for vigilance in evaluating hematuria in older adults. The combination of advanced diagnostic modalities and expert surgical intervention, as demonstrated by the team at the Institute of Urology, Jaipur, ensures high-quality care tailored to individual patients.

References

For more information on bladder cancer diagnosis and treatment, visit: Bladder Cancer Treatment at the Institute of Urology, Jaipur.

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