Prostate cancer and bilateral obstructive uropathy

Case contributed by Seamus O'Flaherty
Diagnosis certain


Presented with macroscopic hematuria, symptomatic anemia and in acute renal failure.

Patient Data

Age: 70 years
Gender: Male

Severely enlarge prostate gland protruding into the base of the bladder. Prostate volume is about 133 cc. There is irregular, lobulated, hyperdense soft tissue within the bladder, with a density reading of 77 HU. Non-specific heterogeneous thickening of the wall of the upper part of the bladder and mild bladder distension. In-dwelling catheter in-situ. A large laminated calcification is seen towards the left side of the bladder. Size is 4.2 x 3.8 x 4cm.

Case Discussion

This patient presented to the emergency department with breathlessness and macroscopic hematuria. He reported a history of several years of intermittent hematuria but had not sought medical attention until this presentation. He had a hemoglobin of 33 g/L and his imaging showed bilateral obstructive uropathy associated with bladder outlet obstruction from prostatomegaly and a large bladder calculus.

Cystoscopy revealed a normal bladder with a large calculus within. Biopsies of the prostate gland confirmed the diagnosis of prostate adenocarcinoma.

The patient required admission to ICU for fluid and blood resuscitation as well as hemofiltration for acute renal failure.

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