A 58-year-old man was a professional taxi driver and a heavy smoker (two packs/day), hypertensive and diabetic, on oral antidiabetic treatment.
History of oxalochal lithiasis since years ago (renal colic and calculi).
Due to an episode of monosymptomatic hematuria with clots, she is diagnosed with multifocal papillary bladder neoformation occupying almost all the bladder accompanied by positive urine cytology (urethral carcinoma).
TUR of the bladder tumor was performed by scheduling a second anaesthesia (EBA), second look, one month after TUR (healing), in order to confirm the absence of tumour remains.
Pathology: Papillary urothelial carcinoma (Jawet-Marshall-system stage A, cytological grade 2).
1.
When the bladder catheter is removed, she presents intense polyuria (mictions every 5-10 minutes), continuous (day and night), voiding and tenesmus without hematuria.
Pending urinary infection, without previous urine culture, antibiotic treatment with quinolones is initiated, which does not improve symptoms.
Urine cytology in the immediate postoperative period is negative.
It is thought of meatus stenosis or post-inflammatory acute urethral stricture after TURP discarded by visual and endoscopic examination.
Urine culture was positive for Enterocococo and urinary pH was 6.7.
Staphylococcus will be identified later.
Second look examination under preview anaesthesia (EBA) shows absence of tumour remains and bladder mucosa covered almost entirely by a thick whitish layer, irregular and hard scarred areas (calcification of bladder edema).
Bladder transurethral resection ( curettage) of the entire affected surface was performed.
The microscopic description of the pathologist was an "intense chronic inflammatory reaction that includes abundant eosinophils and multinucleated foreign-body giant cells, presence of granule-like material (carbonate to bulky colitis), amorphous necrosis.
Cytological atypia, compatible with Incrusted Cystopathy.
Subsequent cultures continued to be positive for Enterococcus spp. and coagulase-negative Staphylococcus on one occasion, despite the different antimicrobial regimens with amoxicillin/clavulanic acid.
Corynebacterium ureticum was never identified, as was initially identified, despite its lack of a microbiologist searching for it.
Urinary pH was always alkaline (>6.5).
In the first weeks, irritative mimicry only improved in intensity.
When culture became negative, the improvement was more evident, although it did not completely disappear.
Currently, after six months there is no evidence of urinary infection or tumor recurrence, with negative urine cytology.
Bladder healing involves retractile bladder, residual calcification, which causes bilateral obstructive uropathy with normal creatinine levels.
Paradogically, irritative mimicry is mild.
To achieve definitive healing, it is thought that you will need urinary diversion (bilateral ureterosigmoidostomy), possibly without cystectomy, requiring bladder cancer monitoring.
