Cystoscopic Appearance of Malignant Bladder Infiltration

Dr CW Cheng, FRCS FHKAM (Surgery)
Medical Officer
Urology Unit
Department of Surgery
Prince of Wales Hospital Shatin, NT Hong Kong

Case History

A 41-year-old woman was diagnosed with stage IIIb carcinoma of the cervix in 1999. She underwent initial laparotomy with pelvic lymphadenectomy and para-aortic lymph node dissection, and received postoperative external beam and intracavitary irradiation.

Post-treatment, she developed renal impairment and computed tomography of the abdomen and pelvis showed bilateral hydronephrosis with persistent pelvic infiltration. The ureteric obstructions were relieved by bilateral percutaneous nephrotomy with resulting improvement in renal function. She underwent cystoscopy with a view for bilateral ascending ureterogram to be followed by internal JJ stenting. On cystoscopy, an abnormal growth was found at the trigone (figure 1), biopsy of which subsequently revealed this to be infiltrative squamous cell carcinoma consistent with persistent carcinoma of the cervix.

Figure 1. Cystscopic appearance of an abnormal growth at the trigone of the bladder

Figure 2. Mucosal oedema at the area surrounding the left ureteric orifice

The site of the left ureteric orifice was surrounded by mucosal oedema (figure 2) and the orifice could not be found. On injection of contrast medium into the right ureteric orifice, there was reflux of all contrast medium back into the bladder without ureterogram seen.