Urosurgery 21 Bladder Carcinoma Long case

• Age of patient -
• Sex -
• Address -
• Occupation -

• •  Passage of blood in urine for .. year 
• • Swelling in abdomen or loin for………….. months/years.
• • Passage of blood in urine for………….. months/years.
• • Increased frequency of micturition for………….. months/years.
• • Difficulty in passing urine for………….. months/years.
• • General symptoms like fever, anorexia, weight loss for………….. months/years.

The patient was apparently well before this episode of illness which started 1 year back when he had

• Passage of blood in urine
• - Insiodious in onset
• - Profuse
• - Blood mixed with urine through out the micturition.
• - H/o passage of clots in urine.
• - Shape of clot - amorphous or Vermiform 
• - Pain during passage of urine (stone)

• Features of LUTS - 
• - FUN WISW

• History of incontinence
• - true or false
• - type of incontinence 

• Fever 
• - UTI,
• - RCC, Wilms tumor

• Rule out malignancy
• - Weight loss
• - Anorexia
• - Malena, Hematemesis, 

• Other causes of hematuria -
• - Sore throat, Skin rashes,  limbs or face swelling (PSGN)
• - Petechiae, Purpura, Ecchymosis (Bleeding tendency)
• - H/o trauma or catheterization before the start of blood in urine.
• -  Pain and swelling in the abdomen and loin (nephritic syndrome, nephrotic syndrome).
• - Pyuria or lithuria (Stone disease, UTI)

• Risk factors for bladder cancer - 
• -  Exposure to textile, rubber, dye, petroleum industries nor has radiation exposure.

• Rule out metastasis - 
• - Jaundice (to liver)
• - Bladder habit (GI malignancy infiltrating bladder)
• - Chest pain, shortness of breath, cough, hemoptysis (chest involvement)
• - Headache, LOC or any focal neurological deficit (CNS metastasis)

• DM, HTN, Thyroid disease
• Pulmonary TB (bladder TB)
• Recurrent UTI or stone disease in the past (squamous cell carcinoma of bladder)

• Smoking 
• Alcohol
• Diet 
• Sleep
• Socioeconomic status 
• Mariatal status, number of children

• DM, HTN, Thyroid 
• Any malignancy in family

• Recent treatment
• - the events after hospital admission
• - any past medial history 

• Surgical history 
• - any past surgeries

any allergy

Pt was sitting comfortably in bed with ____ French 2 way Foley’s catheter in situ containing yellowish urine.

Pt was conscious, alert, cooperative.

Performance status 

Built and cachexic 

BMI

Vitals 

PICCLED

• - Shape - scaphoid, distended, flat
• - Umbilicus
• - All quadrants moving with respiration
• - Skin over the abdomen
• - Scar
• - Pigmentation
• - Venous prominence
• - Swelling on the abdomen and B/L loin
• - Hernial sites
• - External genitalia - Penis and meatus, scrotum, testis

• Superficial palpation - 
• - Local rise in temperature 
• - Tenderness 
• - Obvious swelling

• Deep palpation 
• - Tenderness 
• - Liver 
• - Spleen
• - Kidney and renal angle tenderness 
• - Bladder
• - Palpation of testis, penis and spermatic cord

• General note - tympanic/dull
• Upper liver dullness, Liver span 
• Renal angle percussion - resonant/dull 
• Bilateral lumbar regions (for any mass)

• Bowel sound
• Bruit (of renal artery)

• Anal tone
• Prostate
• - Consistency
• - Surface
• - Median groove
• - Rectal mucosa over prostate

B/L equal air entry with normal vesicular breath sound with no added sound.

S1S2M0

• Grossly intact
• Spine normal
• Pt has normal hearing (Alport syndrome)

Carcinoma UB

• BEP 
• RCC
• Upper urinary tract urothelial cancer
• TB Urinary Bladder