This case involved a middle-aged male patient diagnosed with carcinoma in situ of the bladder. At the time of diagnosis, doctors found no signs of metastasis. Further complicating the patient’s course was a long-standing history of severe kidney disease preventing use of any contrast for radiology studies.
The patient underwent an initial resection before presenting to the defendant for a second opinion. The defendant recommended a transurethral resection (TUR) to completely eradicate all disease and Bacillus Calmette-Guerin (BCG) therapy. The TUR was performed within the following few weeks. During surgery, a partially resected nodular tumor was found on the posterior wall. The tumor was completely resected and staged as a high grade T1 tumor and carcinoma in situ. Postoperatively, BCG therapy was started.
A repeat TUR 4 months later revealed no invasive carcinoma. Urine was collected and cytology was positive for malignant cells. This is fairly typical after a resection and was not immediately concerning. Several more cystoscopies were done and although none showed any evidence of cancer within the bladder, urine cytology was positive for malignant cells on several occasions. The patient was monitored closely with cystoscopies but no additional imaging was ordered.