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[A CASE OF ACUTE EXACERBATION OF INTERSTITIAL PNEUMONIA AFTER ROBOT-ASSISTED TOTAL CYSTECTOMY]
Yasuhiro Numata1, Hiroki Ito1, Tomoyuki Tatenuma1
1The Department of Urology, Yokohama City University Hospital.
Nihon Hinyokika Gakkai Zasshi. the Japanese Journal of Urology
|January 21, 2026
Summary
This case study details a bladder cancer patient who developed acute exacerbation of interstitial pneumonia (IP) post-surgery. Prompt steroid therapy and oxygen support led to recovery, with no tumor recurrence observed.
Area of Science:
- Oncology
- Pulmonology
- Medical Imaging
Background:
- A 79-year-old male diagnosed with urothelial carcinoma with squamous differentiation (pT2N0M0) presented with hydronephrosis and lung abnormalities.
- The patient received neoadjuvant chemotherapy (gemcitabine and cisplatin) followed by robot-assisted radical cystectomy and cutaneous ureterostomy.
Purpose of the Study:
- To report a case of acute exacerbation of interstitial pneumonia (IP) following radical cystectomy for bladder cancer.
- To highlight the successful management of postoperative IP with steroid pulse therapy and high-flow oxygenation.
Main Methods:
- Computed tomography (CT) scans were used for initial diagnosis and monitoring.
- Treatment involved neoadjuvant chemotherapy, robot-assisted radical cystectomy, and subsequent management of acute exacerbation of interstitial pneumonia (IP) with methylprednisolone (mPSL) pulse therapy and nasal high-flow (NHF) oxygen.
- Postoperative follow-up included imaging to assess for tumor recurrence and IP progression.
Main Results:
- The patient developed acute exacerbation of interstitial pneumonia (IP) on postoperative day 2, characterized by decreased SpO2 and diffuse reticular shadows on CT.
- Immediate initiation of methylprednisolone (mPSL) pulse therapy and nasal high-flow (NHF) oxygen resulted in a positive clinical response.
- The patient was successfully weaned from NHF oxygen on postoperative day 9 and discharged with home oxygen therapy, with no worsening of IP.
- Six-month follow-up CT scans showed no evidence of tumor recurrence or progression.
Conclusions:
- Acute exacerbation of interstitial pneumonia (IP) is a potential complication after radical cystectomy.
- Early diagnosis and prompt treatment with systemic corticosteroids and respiratory support are crucial for managing this condition.
- This case demonstrates the efficacy of methylprednisolone (mPSL) pulse therapy and nasal high-flow (NHF) oxygen in resolving postoperative IP, allowing for successful patient discharge and continued oncological surveillance.
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