A clinical observation case of advanced bladder cancer at woman

in the third trimester of pregnancy

Kolmakov A., *Startsev V.

Сlinica do Porto cidade de Lobito (prov. de Benguela, Angola)

Population-based cancer register(St.-Petersburg, Russia)

EAU Baltic Meeting23-25 May 2014

Vilnius, Lithuania

ACTUALITY• Malignant tumors in pregnant women are very rare -

0,07-0,2%.

• The most common cancers in pregnancies: malignant melanoma, cervix cancer and breast cancer.

• Urinary malignant tumors in pregnancies are diagnosed

randomly and infrequently.

• Only 27 published cases of TCC in pregnancies have been founded in available literature (1966-2005).

MATERIAL OF THE STUDY

• The 27 y.o. black female, non-smoking housewife

• On the third trimester of her 7th pregnancy (35/36 weeks)

• Resident of a region with high evidence of bilharziasis

• With clinical macroscopic haematuria and moderate anemia

• Painless haematuria which occurred periodically during 2 weeks before hospitalization.

OUR DILEMMAS

QuestionsQuestions??????• No treatment standards for

bladder cancer treatment in pregnant… What shell we do?

• Right timing for extraction the viable fetus, before the fatal complications of bladder cancer develop?

• What extent is acceptable for conservative treatment of hematuria?

• What is the volume and grade of surgeries?

• What is the method of choice for urinary diversion?

ObjectiveObjective!!!!!!• Control of haematuria and anemia • Preparing fruit for cesarean section• Saving:

– the life of the mother – a child's life

• QoL (life quality)

TREATMENT REGIMENS• The pregnancy process was stopped prematurely,

on the 37-th week, with prior pulmonary fetal maturation

• Caesarean section• Anterior pelvic exenteration + urinary derivation

SECOND DAY AFTER SURGERIES

Histological report

complete infiltration of the whole bladder wall by squamous-cell carcinoma cells, invasion of anterior wall of the uterus + metastasis to the right iliac lymph nodes

RESULTS• Surgery report: Caesarean section was successful. Anterior pelvic

exenterating and pelvic lymph dissection was done. Mainz II pouch technique for construction urinary deviation. The duration of surgery ≈ 4,5 hours. Blood loss volume ≈ 1800 ml.

• The bladder tumor infiltrated the anterior wall of the uterus, and vagina extended into the right side of the common iliac artery.

• Child: Apgar scores of 7/8, weight 2700 g.

• Postoperatively: 2-3 bowel movements, urinated 2-3 times a day. Full control of anal sphincter. The patient was discharged on the 20’th day in good status

• The infant weigh was 3100 g at the final day of hospitalization.

CONCLUSIONS• The choice of Mainz II pouch surgical technique was done

to perform the urinary deviation, to relative simplicity in terms of the time and volume of the surgery. The result was excellent, without any complications.

• The fetus was in a satisfactory condition from the 1-st day of stationary. We need to minimize the surgical trauma and impact, eliminate the source of hemorrhage and maximize the tumor excision.

• Despite the rarity of such rare combination (pregnancy + bladder tumors + haematuria), standard diagnostic tests for exclude urinary tumors should be done in all pregnant women.

Kolmakov Anton stratus030275@gmail.com

Startsev Vladimir doc.urolog@gmail.com