Recurrence of bladder cancer in the urethra

Introduction. Bladder cancer (ВС) is one of the most common malignant tumors of the urinary tract. In recent decades, recurrent BC in the urethra has become increasingly common. Given the rarity of this pathology, it is of clinical interest for oncologists and urologists. Materials and methods. A clinical case of recurrent bladder cancer in the urethra in a 63-year-old patient is presented. The results of magnetic resonance imaging (MRI) of the pelvic organs and external genital organs, as well as the results of computed tomography of the abdominal organs and observation by a hematologist are presented. Results. For early diagnosis of tumor changes in the urethra in patients with risk factors for the recurrence of BC after cystectomy, careful observation in the form of a cytological study of flushing water from it, performing urethroscopy with ascending urethrography and MRI of the external genital organs is advisable. Conclusions. This clinical observation demonstrates the importance of assessing the state of the urethra when follow up patients after radical cystectomy for BC.

Epirubicin-induced Kounis syndrome

Background Kounis syndrome is an acute coronary syndrome that appears in the setting of anaphylactic reaction or hypersensitivity. Many drugs and environmental exposures have been identified as potential offenders, and diagnosis and treatment can be challenging. Case presentation A 62-year-old man with recurrent bladder cancer underwent an intra-iliac artery epirubicin injection. After the injection, he developed chest pain and a systemic allergic reaction, with electrocardiographic alterations and elevated troponin-I levels. Emergent coronary angiography showed right coronary artery spasm and no stenosis of the other coronary arteries. This reaction was considered compatible with an allergic coronary vasospasm. A diagnosis of Kounis syndrome was made. Conclusions Kounis syndrome is common, but a prompt diagnosis is often not possible. This case is the first to suggest that an intraarterial epirubicin injection could potentially be one of its triggers. All physicians should be aware of the pathophysiology of this condition to better recognize it and start appropriate treatment; this will prevent aggravation of the vasospastic cardiac attacks and yield a better outcome.