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Can burning sensation during urination, vomiting and weakness be treated in a diabetic?

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Posted on Fri, 20 Nov 2020
Question: Hello doctor,
This is for my mom-in-law. She is diabetic for last 20 yrs. Her creatine level is 5. She is having burning sensation while passing urine. Whatever she eats, she was vomiting and she is very weak. She had blood in the urine.I have attached her blood work and scan report. Please advise.
Thanks in advance!
doctor
Answered by Dr. P. T. Patil (10 hours later)
Brief Answer:
Your Mother in law has Diabetic Nephropathy with tumor in bladder .

Detailed Answer:
Hello
Thanks for query .

Based on the facts and reports that you have posted your Mother in-law has Diabetic Nephropathy .

Blood in urine (Hematuria) that she has is mostly due to a tumor detected in bladder and needs to get investigated by doing few more test like
1) C.T Scan of abdomen and Pelvis
2) Endoscopic examination of bladder (Cystoscopy) and biopsy of the tumor which will help to ascertain nature of the tumor and to decide further modality of treatment .

Consult qualified Nephrologist and Urologist for further evaluation and management

Further treatment will depend upon result of these tests and final diagnosis. .

Hope I have answered your query ,please feel free to ask if you have more questions,I shall be happy to help you
Thanks and Regards.
Dr.Patil.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. P. T. Patil (21 hours later)
Hello doctor,
Thanks for your reply.
1) Is there any relation between C.T Scan and the creatine level. i.e. Since she has creatine as "5", is it an issue to get the CT Scan. Instead, do we need to go for MRI scan?
2) Can we remove the tumor while doing Cystoscopy procedure and then we can send the tumor for biopsy?
3) Is it CT/MRI Scan & Cystoscopy needs to be done parallel or we can do Cystoscopy & Biopsy, depends on the result we can do scan if required?
4) Is there any possibility to be a CA tumor? If so, what are the procedures to be carried out? Is it completely curable?
5) Is there any possibility to bring back the creatine level from 5 to 1?
6) When the Sugar is in control, will there be any possibility to have elevated Creatine level?
Thanks in Advance!
doctor
Answered by Dr. P. T. Patil (58 minutes later)
Brief Answer:
Since her creatinine level is high .You can go for MRI

Detailed Answer:
Hello
Thanks for follow up
I would answer your queries point to point
1) Since her creatinine levels are high You can not go for C T Scan You have to do MRI.

2)Yes tumor can be resected endoscopically and the tissue is sent for biopsy .That is a routine protocol .

3)Tumor is resected by endoscopic procedure called TURBT .CT Scan or MRI are done to see extent of tumor whether it is localized or infiltrated to surrounding structures or lymph nodes or other organs like liver ,etc.

4)Treatment modality depends upon whether tumor is benign or Malignant and grade of the tumor and also whether it has spread to other organs like liver ,brain or lymph nodes .Prognosis depends upon the grade and extent of spread the tumor is spread to .

5 & 6) Since she is diabetic her creatinine levels are high due to Diabetic Nephropathy which can not be brought down to normal but can be controlled with dietary measures and medications to reasonably acceptable range .

Thanks and Regards
Dr Patil.




Above answer was peer-reviewed by : Dr. Raju A.T
doctor
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Follow up: Dr. P. T. Patil (18 hours later)
Hello doctor,

Thanks for the reply. We have done a MRI scan today and pfa herewith the report for your reference. W.r.to the report please suggest us whether cystoscopy and biopsy is required for next step or any other treatment required. Also as the creatine value is 5, shall the biopsy and cystoscopy can be done or we need to wait to bring down the creatine levels before the procedure. Is the tumor cancerous or not? How can we bring down the creatine level? Thanks in advance!
doctor
Answered by Dr. P. T. Patil (5 hours later)
Brief Answer:
She has Bladder tumor whichhas infiltrated in muscle layer

Detailed Answer:
Hello
Thanks for uploading MRI Report .
It reveals bladder tumor which has spread beyond mucosa and infiltrated in to muscle of the bladder wall.

Removal of the bladder (Radical Cystectomy ) is the ideal treatment however considering the comorbidity (Diabetic Nephropathy and her age I would suggest to go for little conservative treatment of Resection of tumor endoscopically (TURBT)which can be done at this stage There is no need to wait till creatinine level comes down .This should be followed by chemotherapy (If required)and doing check cystoscopy at frequent intervals of every six months to assess recurrence of tumor.

The precise nature of the tumor as regards whether it is cancerous or benign would be known after submitting the pieces for histopathological examination .

Thanks and Regards
Dr Patil


Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Dr. P. T. Patil

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Practicing since :1971

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Can burning sensation during urination, vomiting and weakness be treated in a diabetic?

Brief Answer: Your Mother in law has Diabetic Nephropathy with tumor in bladder . Detailed Answer: Hello Thanks for query . Based on the facts and reports that you have posted your Mother in-law has Diabetic Nephropathy . Blood in urine (Hematuria) that she has is mostly due to a tumor detected in bladder and needs to get investigated by doing few more test like 1) C.T Scan of abdomen and Pelvis 2) Endoscopic examination of bladder (Cystoscopy) and biopsy of the tumor which will help to ascertain nature of the tumor and to decide further modality of treatment . Consult qualified Nephrologist and Urologist for further evaluation and management Further treatment will depend upon result of these tests and final diagnosis. . Hope I have answered your query ,please feel free to ask if you have more questions,I shall be happy to help you Thanks and Regards. Dr.Patil.