A 27 year old primigravida with a three year history of recurrent urinary tract infections (UTIs) experienced persistent haematuria and UTIs in pregnancy despite prophylactic antibiotics. At 37 weeks she presented with severe lower abdominal pain. An emergency Caesarean section was performed for a suspicious cardiotocograph. She was not in labour. Frank haematuria was noted at catheter insertion. Post-operative removal resulted in urinary retention. Pelvic ultrasound scan showed a suspiciously thickened, irregular, vascular anterior bladder wall. A urology opinion was sought but the ultrasound findings were attributed to her recent Caesarean section. Six weeks post partum she was admitted with sepsis, renal impairment and hypercalcaemia. Pelvic CT scan showed a large calcified bladder lesion. Cystoscopy proved this to be an extensive tumour. She required renal dialysis prior to a radical cystectomy for stage 4 squamous cell carcinoma. Four months after she developed severe left hip pain. MRI revealed a large recurrent tumour mass destroying the left pubic bone. She received radiotherapy and was referred to the Macmillan team for palliative care.
Bladder cancer is rare in young women. More than 90% are transitional cell carcinomas. Squamous cell carcinomas account for only 2% in the UK but can develop on a background of chronic inflammation. Prognosis is good for early tumours amenable to transurethral resection, however locally advanced tumours carry a poor prognosis. Pregnancy does not influence outcome but treatment depends on gestation and staging. This case demonstrates a rare complication of recurrent UTI's and why persistent haematuria requires investigation.
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