Urologist opines on standard of care for patients with unexplained persistent hematuria

Case Overview

This case takes place in Alaska and involves a fifty-five-year-old male patient who presented to his primary care physician complaining of six month history of hematuria and groin and hip pain. The patient also reported that he was experiencing occasional twitching sensations in the tip of his penis at the time. The physician suggested that the penile twitching sensation may be caused by sacral nerve root irritation. The physician did a work up of the patient for the hematuria and referred him to a urologist. The treating urologist performed a cystoscopy and ordered a CT scan. Both investigations were normal and the urologist did not believe further investigation was warranted and he discharged the patient. The patient continued to experience these symptoms and a second cystoscopy was performed some time later. This revealed an abnormal thickening consistent with a bladder tumor. A cystology report found atypical cells present suspicious for urothelial carcinoma. Subsequently, a transurethral resection of the bladder revealed a large, sessile, poorly differentiated appearing bladder tumor in the right lateral, toward posterior wall. The pathology report revealed high grade transitional cell carcinoma of the bladder with invasion into the muscle. The patient died due to the cancer shortly thereafter. It was alleged that by failing to order serial urine cytology testing despite months of persistent unexplained hematuria, gross and microscopic, the treating urologist did not deliver adequate care.