42 year old female from Oman had an episode of blood in urine was advised DJ Stenting but Dr. Soumyan Dey diagnosed her blood urine was due to cancer.
The patient had HAEMOGLOBIN of 7 against her normal baseline of 10.5), her serum creatinine was 1.1, her urine culture was positive for E coli, she was treated with antibiotics and her Hematuria subsided. Her current sonography has shown hydronephrosis but no definite mass in her urinary tract, her CT scan also showed ureteric obstruction but there was no evidence of growth/SOL (CANCER). She was advised DJ Stenting, and she came to India for further treatment.
Based on the past history above information, in 2021 Doctors at Oman suggested a DJ stenting followed by a URETEROURETEROSTOMY (removal of diseased part of ureter, and joining the healthy ends surgically)/ Nephrectomy ( Kidney Removal) if kidney function does not improve after stenting.
However, in veiw of the history of hematuria with anaemia, Dr Soumyan Dey suspected malignancy. He asked the patient a PET CT scan. It showed bright areas within kidney, high SUV values 4, almost diagnostic of malignancy. We could not do a ureteroscopy or flexible ureteroscopy in view of stricture in ureter. As the Renogram has shown poor function , Nephrectomy was planned.
In 2019, the patient underwent treatment in a reputed hospital in Navi Mumbai for same problem. She underwent a RGP, ureteroscopy and DJ Stenting, for SUSPECTED STRICTURE URETER ON CT SCAN, followed by stent removal after a month. Then her kidneys were functioning very well as per the CT scan. Surgery for ureteric stricture was not advised during stent removal.
We made a preoperative diagnosis of cancer which changed management.
In view of ureteric stricture we planned a NEPROURETERECTOMY , REMOVAL OF A CUFF OF BLADDER, HILAR AND PARACAVAL LYMPH NODE DISSECTION.
Our logic behind the plan: In case the histopathogy shows up a urothelial cell cancer instead of Renal cell cancer, we shall avoid a second operation of ureter and bladder cuff removal.
We carried out a “Neproureterectomy, Removal Of A Cuff Of Bladder, Hilar And Paracaval Lymph Node Dissection” The histopathology was indeed a transitional cell cancer, with para caval lymph node positive disease. She is now undergoing chemotherapy.