Indian Journal of Urology Users online:2746  
IJU
Home Current Issue Ahead of print Editorial Board Archives Symposia Guidelines Subscriptions Login 
Print this page  Email this page Small font sizeDefault font sizeIncrease font size


 
  Table of Contents 
CASE REPORT
Year : 2019  |  Volume : 35  |  Issue : 4  |  Page : 301-302
 

Transurethral resection of bladder tumor in a case of metastatic carcinoma prostate with penile prosthesis implant


Department of Urology, Aster MIMS Hospital, Kozhikode, Kerala, India

Date of Submission09-May-2019
Date of Acceptance25-Jul-2019
Date of Web Publication1-Oct-2019

Correspondence Address:
Mihir Pandya
Department of Urology, Aster MIMS Hospital, Kozhikode, Kerala
India
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/iju.IJU_144_19

Rights and Permissions

 
   Abstract 

Synchronous presentation of genitourinary tract malignancies is common, and more so for carcinoma prostate and carcinoma urinary bladder. Each of the carcinomas is treated as per their stage at presentation. Here, we report a case of metastatic carcinoma prostate with penile implant presenting with bladder lesion managed by transurethral resection of bladder tumor (TURBT) through perineal urethrostomy.



How to cite this article:
Pandya M, Lal J, Karunakaran R. Transurethral resection of bladder tumor in a case of metastatic carcinoma prostate with penile prosthesis implant. Indian J Urol 2019;35:301-2

How to cite this URL:
Pandya M, Lal J, Karunakaran R. Transurethral resection of bladder tumor in a case of metastatic carcinoma prostate with penile prosthesis implant. Indian J Urol [serial online] 2019 [cited 2019 Oct 21];35:301-2. Available from: http://www.indianjurol.com/text.asp?2019/35/4/301/268297



   Introduction Top


Bladder tumor is the second most common genitourinary malignancy, and it can occur commonly with other genitourinary malignancies, usually prostate. The incidence of concomitant presentation of carcinoma prostate and carcinoma bladder is 18–19 times more common than normal population.[1]

The initial assessment and management of patients with bladder lesion involve cystourethroscopy followed by transurethral resection of bladder tumor (TURBT). The presence of a penile implant may make TURBT difficult. Perineal urethrostomy is indicated for long segment stricture which failed conservative management and urethroplasty,[2] total penectomy for carcinoma penis,[3] inaccessibility to bladder due to obesity for transurethral resection.[4] We describe the use of a perineal urethrostomy to perform TURBT in this patient.


   Case Report Top


An 80-year-old patient with a Shah® malleable penile implant since 11 years came with complaints of back pain for 6 months and voiding difficulty. His prostate-specific antigen was 77.67 ng/ml, and ultrasonography showed a lesion of 4 cm on the right lateral wall of bladder with prostatomegaly. Core biopsy of the prostate showed adenocarcinoma of prostate with Gleason score 8 (4 + 4) with perineural invasion. Prostate-specific membrane antigen (PSMA) - positron emission tomography (PET) showed PSMA positive tumor involving the prostate gland with intense PSMA uptake along left superior poster lateral peripheral wall region. PSMA expressing metastatic lesion involving enlarged left supraclavicular, retroperitoneal, and bilateral iliac nodes and disseminated sclerotic lesions involving base of the skull, multiple cervical, dorsolumbar vertebrae seen, sternum, clavicle, scapulae sacrum, pelvis, and bilateral femori. PSMA – PET showed a non-PSMA avid soft-tissue mass lesion of 4 cm in the right lateral wall of bladder; and hence, contrast enhanced computed tomography of abdomen was done which showed a contrast-enhancing lesion on the right lateral wall of bladder [Figure 1]. The patient was planned for TURBT. The patient was counseled for a perineal urethrostomy and that it is advisable to have permanent perineal urethrostomy for follow-up and reresection; however, he refused the creation of permanent urethrostomy. A rigid resectoscope could be passed through the meatus only till the prostatic urethra and the tumor was visualized using flexible cystoscopy. A perineal urethrostomy was created through a midline perineal approach [Figure 2]a, and 2 cm opening was made in bulbar urethra through which resectoscope was passed [Figure 2]b and tumor was resected completely. The urethrostomy was closed [Figure 2]c and a urethral catheter was placed for continuous bladder irrigation. The histopathology showed high grade papillary urothelial carcinoma without muscle invasion. He was started on luteinizing hormone-releasing hormone agonists for his prostate cancer.
Figure 1: Computed tomography image of bladder tumor

Click here to view
Figure 2: (a) Approach to perineal urethrostomy (b) Resection of tumor with resectoscope (c) Closed perineal urethrostomy

Click here to view



   Discussion Top


Synchronous malignancies of the genitourinary tract are not rare, and these malignancies are treated as per their stage at the time of presentation. There is a paucity of literature mentioning TURBT in a patient with penile implant where rigid resectoscope could not be negotiated. One case report has mentioned TURBT in case of penile implants, but they were able to resect tumor through per urethral route.[5] Our case of perineal urethrostomy for TURBT in a case of penile implant is novel and can be used for other conditions where per urethral access becomes difficult like complete urethral strictures.

Declaration of patient consentd

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship: Nil.

Conflicts of interest: There are no conflicts of interest.

 
   References Top

1.
Abbas F, Hochberg D, Civantos F, Soloway M. Incidental prostatic adenocarcinoma in patients undergoing radical cystoprostatectomy for bladder cancer. Eur Urol 1996;30:322-6.  Back to cited text no. 1
    
2.
Belsante MJ, Selph JP, Peterson AC. The contemporary management of urethral strictures in men resulting from lichen sclerosus. Transl Androl Urol 2015;4:22-8.  Back to cited text no. 2
    
3.
Christodoulidou M, Sahdev V, Muneer A, Nigam R. A rare case of metachronous penile and urethral metastases from a rectal mucinous adenocarcinoma. BMJ Case Rep 2015;2015. pii: bcr2015212706.  Back to cited text no. 3
    
4.
Papagiannopoulos D, Deane LA. Perineal urethrostomy: Still essential in the armamentarium for transurethral surgery. Rev Urol 2017;19:72-5.  Back to cited text no. 4
    
5.
Senda M, Otani T, Ito Y. A case of TURBT after penile prosthesis implantation. Hinyokika Kiyo 2006;52:629-32.  Back to cited text no. 5
    


    Figures

  [Figure 1], [Figure 2]



 

Top
Print this article  Email this article
 

    

 
   Search
 
  
    Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
    Article in PDF (825 KB)
    Citation Manager
    Access Statistics
    Reader Comments
    Email Alert *
    Add to My List *
* Registration required (free)  


    Abstract
   Introduction
   Case Report
   Discussion
    References
    Article Figures

 Article Access Statistics
    Viewed70    
    Printed1    
    Emailed0    
    PDF Downloaded6    
    Comments [Add]    

Recommend this journal

HEALTHWARE INDIA