A male tetraplegic patient with, who had been taking
warfarin, developed haematuria. Ultrasound scan revealed no masses, stones, or
hydronephrosis. Urinary bladder had normal configuration with no evidence of masses or organised haematoma. Urine cytology revealed no malignant cells. Four months later, CT urography revealed an irregular mass at the base of urinary bladder. Cystoscopic biopsy revealed moderately differentiated
adenocarcinoma, which contained goblet cells and pools of
mucin showing strongly positive immunostaining for prostatic
acid hosphatase and patchy staining for
prostate specific antigen. Computed Tomography revealed multiple hypodense hepatic lesions and several osteolytic areas in femoral heads and iliac bone. With a presumptive diagnosis of prostatic
carcinoma,
leuprorelin acetate 3.75 mg was prescribed. This patient expired a month later. Conclusion. (i)
Spinal cord injury patient, who passed blood in urine while taking
warfarin, requires repeated investigations to look for
urinary tract neoplasm. (ii) Anti-
androgen therapy should be prescribed for 2 weeks prior to administration of
gonadorelin analogue to prevent tumour flare causing bone
pain,
bladder outlet obstruction, uraemia, and cardiovascular risk due to
hypercoagulability associated with a rapid increase in tumour burden. (iii) Spinal cord physicians should adopt a caring and compassionate approach while managing tetraplegic patients with several co-morbidities, as aggressive diagnostic tests and therapeutic procedures may lead to deterioration in the quality of life.