Delayed diagnosis of pediatric bladder and prostate rhabdomyosarcoma – causes and consequences

Introduction: Pediatric rhabdomyosarcoma (RMS) is a rare disease, affecting 4.5-6.0 per 1 000 000 children a year. Bladder and/or prostate (B&P) is the primary tumor site in approximately 10% of patients. Initial symptoms of B&P RMS in children may mimic more common, benign conditions such as urinary tract infections (UTIs), functional disorders, and congenital anomalies of the urinary tract. Aim: The study aims to emphasize the role of careful clinical examination and strict following the diagnostic guidelines in early detection of pediatric B&P RMS in primary care and emergency department settings. Case study: We present two male patients aged 2.5 and 3 years with embryonal B&P RMS initially manifesting as atypical and/or recurrent UTI. In both children, proper diagnoses were delayed due to careless physical examination and failure to adhere to the current guidelines for UTI management. Despite symptoms of an atypical and severe course of UTI, no imaging examinations had been performed for several weeks until dramatic deteriorations of patients’ general conditions occurred. Results and discussion: The prolonged diagnostic processes caused unnecessary suffering of both children and significant delay of oncological treatment in one. In the latter patient, bladder preservation was not possible, resulting in decreased quality of life. Conclusions: Due to its rarity, B&P RMS is infrequently included in the differential diagnosis in children with recurrent or atypical UTI. However, thorough physical examination and adherence to the guidelines of UTI management enable timely diagnosis of underlying malignancy. Early diagnosis of B&P RMS leads to a better prognosis, less intensive treatment, and improved quality of life of B&P RMS survivors.