Metastatic breast cancer presenting as detrusor overactivity

Breast carcinoma metastatic to the bladder is rare and accounts for approximately 3% of all secondary bladder neoplasms. We examine a case of breast cancer metastatic to the bladder with normal findings at cystoscopy. A 53-year-old woman with a history of breast carcinoma presented with a 6-month history of severe urgency and urgency incontinence. Treatment with multiple antimuscarinic therapies was unsuccessful. Vaginal examination demonstrated a non-mobile uterus with a suggestion of parametrial thickening. Urodynamic studies confirmed detrusor overactivity. CT showed a thickened bladder wall and cystoscopy revealed normal bladder mucosa with reduced bladder capacity. Bladder biopsies identified a poorly differentiated adenocarcinoma with strong oestrogen receptor staining. This was reported as a secondary deposit from a primary breast malignancy. The patient is currently under the care of the breast team and undergoing palliative chemotherapy.