A 48-year-old male, with smoking behaviour and no past medical nor surgical history, complaining of burning micturition and paroxysmal terminal haematuria evolving since last year. He showed no lower back pain and no deterioration of the general status. Tests are normal with Hb =13 g/l serum; creatinine =90 mumol/l and a CBEU showing leukocyturia = 50/mL with a negative culture.
A renal ultrasonography was made and showed a burgeoning lesion of 3 cm at the base on the left side of the bladder. The patient had a transurethral vesical tumor resection.
The histology concluded a papillary urothelial carcinoma high grade classified pT1G3 with Squamous differentiation to 25% and glandular to 5%.
As part of the staging assessment, thoraco-abdomino-pelvic computed tomography scan (Fig. 2) and bone scintigraphy did not show secondary locations.
With the presented assessments, we practiced a radical cystectomy with urinary incontinent derivation of Bricker. The post-operative outcome was simple and the patient has been released on the seventh postoperative day.
Histology of the removed part did not show any tumoral hearth, but objectified a macrophagic and gigantocellular granulomatous reaction containing caseous necrosis on the posterolateral wall of the bladder confirming the diagnosis of tuberculosis. The patient took his anti-TB drugs -according to the protocol- 2 months of HRZE then 6 months of HR by adapting the amounts according to his weight. The outcome was satisfying with a good tolerability and with no side effects.