Primary bladder amyloidosis as a cause of haematuria
Description
◉ Patient Background
• Age/Sex: male, 46 years old
• Ethnic background: Syrian
• History: A number of sporadic, excruciatingly painful episodes of haematuria
• Absence of related urinary symptoms
• Culture of urine: No growth
• Way of life: moderate smoker
• No noteworthy medical history or environmental risk factors for cancer of the urothelium
◉ Investigations:
• Normal CT Intravenous Pyelogram (CT IVP)
• Cytology of urine: Normal
• Flexible cystoscopy:
• region of the posterior bladder wall that is erythematous
• diffuse bladder mucosa that is yellow in color
• Results of the biopsy:
• Amyloidosis of the AA type
• Histology:
• H&E stain: Material that is amorphous and eosinophilic
• Under polarized light, Congo red stain exhibits apple-green birefringence.
• Six months later, repeat cystoscopy: Amyloidosis persistence
• Repeat CT: Found a new bladder lesion
• Resection: Amyloidosis was confirmed once more; there was no cancer.
◉ Distinctive Diagnosis and Systemic Assessment:
• Suspected systemic amyloidosis → recommendations to:
• Haematology
• Rheumatology
• The field of gastroenterology
• Numerous inquiries revealed no evidence of systematic participation.
• Primary localized bladder amyloidosis was the final diagnosis.
Protocol
◉ Management & Therapy:
• Discussion in a multidisciplinary team (MDT):
• Diagnosis: Primary bladder amyloidosis with unusual behavior
• Conservative management due to a lack of symptoms
• Plan:
• monitoring with cystoscopy every six to twelve months
• Keep an eye out for any new lesions or progression.
• Other forms of treatment (as documented in the literature):
• Colchicine
• Dimethyl Sulfoxide Intravesical (DMSO)
• usually not necessary for stable or asymptomatic conditions.
◉ Nursing Problem
• Anxiety
• Hematuria
• Postoperative care
• Lack of knowledge and recurrence risk
◉ Comprehensive Nursing Interventions
• To ease concerns about presenting symptoms and possible diagnosis, offer factual information and psychological support.
• Get the patient ready for invasive diagnostic and surgical treatments on both a physical and mental level.
• Keep a close eye out for urinary issues like infection, hematuria, and clot retention.
• Provide post-discharge instructions, such as activity limitations, fluid intake guidelines, and monitoring for problems or recurrence.
• assistance in making decisions and obtaining ethical and legal approval for operations.
Notes
FOR MORE DETAILS VISIT:https://pmc.ncbi.nlm.nih.gov/articles/PMC6058111/?utm_source=chatgpt.com
