by Internet Medical Society

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.
Bright area on pet scan suggesting cancer
No definite mass on the ct scan as kidney was non functioning
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.

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