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Strangury: the case of a symptom with ancient origins
  1. Bethany Wright1 and
  2. Emma Husbands2
  1. 1Department of Palliative Medicine, St Richard's Hospice, Worcester, UK
  2. 2Department of Palliative Medicine, Gloucestershire Royal Hospital, Gloucester, UK
  1. Correspondence to Dr Bethany Wright, St Richard's Hospice, Wildwood Drive, Worcester WR5 2QT, UK; bethanywright{at}doctors.org.uk

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Introduction

We describe a case of strangury, caused by bladder cancer, which failed to respond to conventional treatments typically used in bladder spasm. Strangury, which describes the slow and painful discharge of small volumes of urine, is a term which is rarely used in the palliative care literature but remains an entity distinct from bladder spasm. To our knowledge, there have been no previous reports relating to this debilitating symptom in patients with progressive disease, or to its palliative management.

Case history

An older man with transitional cell carcinoma of the bladder was referred with intractable urinary symptoms. He described intermittent excruciating pain associated with the involuntary voiding of small volumes of blood-stained urine. These waves of pain were unremitting, restricting him during the day and frequently interrupting his sleep. Each episode was so unpredictable and incapacitating that he had been left effectively housebound. The relentless, overwhelming nature of this pain had led him to feel that his life was no longer worth living. He lived alone and had no close family. His comorbidities included stage 3 chronic renal impairment and ischaemic heart disease.

Since his original diagnosis several years …

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