Situational awareness:Haematuria while standing, pain while lying down. Two mysteries solved

A 70-year-old patient came to the hospital with haematuria leading to anaemia. He had a previous diagnosis of urothelial bladder tumour, which had progressed into the bladder, after previous treatment with chemotherapy and radiotherapy. The relapse was in the form of a lump inside the bladder, which was responsible for the haematuria with clots, obstructing the urethra and causing pain.

Clinical Evolution

The patient reported pain in the right renal area, since a nephrostomy was recently changed, and that it was continuous while he was in decubitus position, but improved when he sat up. On the other hand, he also commented that the haematuria appeared with greater intensity when he sat upright. He did not want to get out of bed because the haematuria increased. For some time the attending physician was tried to find out the pathophysiology of the patient’s pain and the recurrence of haematuria when standing up.

A urologist solved the problem

At the request of the doctor in charge, a young urologist was called in, and quickly solved the mystery. Do you have any suggestions yet?

If not, you can find the explanation in the following VIDEO

Experience is a degree

Medical work in the clinic involves keeping the mind awake and active to explain what we cannot initially answer, but which worries us or worries us because we do not know how to fit it into the patient’s clinical picture.

Author: Lorenzo Alonso Carrión

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