Emphysematous Cystitis in a Patient with Metastatic Prostate Cancer Co-existing with Benign Prostatic Hypertrophy: A Case Report

Abstract

Introduction: Emphysematous cystitis is a potentially life-threatening infection characterized by gas within the bladder wall and lumen due to gas-forming bacteria. Risk factors include diabetes mellitus and urinary stasis with cases occurring more often in women than men.

Method: A 70-year-old retired civil servant who had a bilateral orchidectomy on account of metastatic prostate cancer about three years ago at Usmanu Danfodiyo University Teaching Hospital, Sokoto, presented to our clinic at the same institution. The patient later developed urinary obstruction, which led to his catheterization about five (5) months ago. About three weeks later, he started having bladder spasms, evident by leakage of urine despite being on the catheter. The patient was placed on the antimuscarinic agent (Tolteridine) with no significant improvement. An abdominopelvic ultrasound scan was requested on 14/05/2024.

Results: Report of the abdominal ultrasound scan (15/05/2024) reveals emphysematous cystitis. Urine microscopy and sensitivity were requested, and the catheter was changed immediately (16/05/2024). The urine sample was taken before and after changing the catheter. Escherichia coli and Staphylococcus aureus were isolated from both samples. The Escherichia coli was sensitive to Imipenem and Amikacin while Staphylococcus aureus was sensitive to Gentamicin and Cefoxitin. A pelvic X-ray done on 22/05/2024 reveals a focal area of translucency. The patient is a known diabetic and hypertensive. He had two (2) pints of blood transfusion about two months ago (09/03/2024). The patient has been on tamsudard (Tamsulosin and Finestride) on account of the co-existing benign prostatic hypertrophy. He is currently awaiting surgery (Trans Urethral Channelization of the Prostate) after successful treatment of the infection.

Conclusion: Invasive procedures and instrumentation can predispose cancer patients to risks of a variety of infections. Effective infection prevention and control practice is recommended to improve patient’s quality of life.