CASE HISTORY

Patient was admitted complaining of retention of urine. For 6 months or more he had had difficulty in micturition and marked frequency, which had been progressive. For 3 days before admission he had been unable to pass water. On admission he had a markedly distended bladder, which was slowly decompressed by a tied-in rubber catheter. He looked very ill, with a dry furred tongue and septic teeth. The heart was very irregular and fibrillating. Bp 180/110. Incontinent of faeces. Prostate was enlarged and irregular (PR). Blood urea 61mg per100 cc. Urine contained some RBC and some leucocytes. Direct examination showed Gram negative bacilli and Gram-positive cocci in large numbers. The culture yielded a heavy growth of Proteus vulgaris and Bact. alkaligenes. One week after admission a suprapubic tube was inserted, which drained well, but the patient's condition got rapidly worse and he died 16 days after admission. The clinical diagnosis was cancer of prostate.

PATHOLOGY

Two specimens have been mounted- the bladder and the left kidney. The bladder has had the front wall removed to expose a large cauliflower-like tumour arising somewhere at the base and largely filling the bladder. The bladder itself is hypertrophied and shows trabeculation. The left kidney has had its front portion removed to show that there is gross hydronephrosis. The pelvis is greatly dilated and there is tumour in it about 2 cm above the junction of the pelvis with the ureter. There is another deposit in the ureter just below the junction and there is tumour filling and obstructing the lower end of the ureter. All these tumours have a rather papillary appearance.