Intraperitoneal Bladder Perforation Research Articles

Important Points of Diagnosis and Treatment Strategy of Intraperitoneal Bladder Perforation due to Blunt Pelvic Trauma in a Pediatric Case

Important Points of Diagnosis and Treatment Strategy of Intraperitoneal Bladder Perforation due to Blunt Pelvic Trauma in a Pediatric Case

AB136. SOH23ABS_122. Management of intraperitoneal bladder rupture with ultrasound guided percutaneous drain insertion: a case report

Background: Intraperitoneal rupture of the bladder is a rare but significant complication of transurethral resection of bladder tumour (TURBT) with a high degree of associated morbidity and mortality. These patients are also exposed to a significant risk of developing TURBT syndrome secondary to intraperitoneal extravasation of irrigation fluid resulting frequently in electrolyte imbalances. Conventional management of intraperitoneal bladder rupture consists of formal laparotomy and open surgical repair. There is growing interest in less invasive management of bladder perforation in haemodynamically stable patients. We present one such case of intraperitoneal bladder rupture which was successfully managed with percutaneous drain insertion under ultrasound guidance. Percutaneous drain insertion is a novel, minimally invasive approach which has proven successful in the management of uncomplicated intraperitoneal bladder perforation. Three cases successfully utilising this treatment modality have been reported in the literature to date. Despite being performed in many institutions, there is a clear lack of reporting in the literature. This case study aims to add to the growing body of research supporting the use of percutaneous drainage in the management of uncomplicated intraperitoneal bladder rupture.

Retrospective analysis of bladder perforation risk in patients after augmentation cystoplasty using an extraperitoneal approach

Initial management of pediatric patients with neurogenic bladder is focused on clean intermittent catheterization and medical therapies. Those with more hostile or small capacity bladders require surgical intervention including bladder augmentation that can result in significant clinical sequelae. This study examines a rarely described approach wherein the bladder reconstruction is extraperitonealized by bringing bowel segments through a peritoneal window and then closed. The aim of this study was to determine if the rate of bladder rupture and subsequent morbidity differed between patients who have undergone an intraperitoneal versus extraperitoneal bladder augmentation. We hypothesized that an extraperitoneal approach reduced the risk of intraperitoneal bladder perforation, downstream Intensive Care Unit (ICU) admission, small bowel obstruction (SBO) requiring exploratory laparotomy, and ventriculoperitoneal (VP) shunt-related difficulties as compared to the standard intraperitoneal technique. A retrospective chart review was conducted to assess surgical approach and outcomes in patients who underwent bladder augmentation performed between January 2009 and June 2021. Patients were identified through an existing database and manual chart review was conducted to extract data through imaging studies, operative notes, and clinical documentation. The primary outcome was bladder perforation. Secondary outcomes were ICU admission, exploratory laparotomy, and VP shunt externalization, infection, or revision for any cause. Nonparametric statistical analyses were performed. A total of 111 patients underwent bladder augmentation with 37 intraperitoneal and 74 extraperitoneal procedures. Median follow up was 5.8 years [IQR 3.0-8.6 years] and did not vary between groups (P=0.67). Only one patient was found to have a bladder perforation in the intraperitoneal group (log-rank P=0.154). There were no significant differences in time to post-augmentation ICU admission, exploratory laparotomy, or VP shunt events between the two groups (log-rank P=0.294, log-rank P=0.832, and log-rank P=0.237, respectively). Furthermore, a Kaplan-Meier analysis assessing time to composite complication demonstrated no significant difference between the two techniques (log-rank P=0.236). This study provides important data comparing the rate of bladder perforation and subsequent morbidity between intraperitoneal and extraperitoneal bladder augmentation. As expected, with a complex procedure, both groups suffered complications, but these data showed no difference between the two procedures. Rates of prior (abdominal) surgery may influence the decision to perform this procedure extraperitoneal. Outcomes related to bladder perforation and secondary consequences do not differ significantly between patients who had bladder augmentation performed with an intraperitoneal versus extraperitoneal approach. Given the low number of adverse events in this study, larger studies are warranted.

Enterovesical Fistula Presenting with Gross Hematuria and Fecaluria after Pelvic Radiation Therapy and Transurethral Resection of Bladder Tumor: A Case Report and Literature Review

<p>本案例為一名75歲女性表現為肉眼可見的血尿兩天，過去病史有10年前子宮頸癌第四期接受過骨盆腔放射治療、高血壓及第2型糖尿病。病人到本院急診就醫後住院接受進一步檢查，住院後第2天膀胱鏡發現出血性膀胱炎，住院後第4天接受經尿道膀胱腫瘤切除術，病理報告顯示為膀胱急慢性發炎併出血。病人於手術後第四天出院。病人於手術後第10天出現下腹痛、肉眼可見的血尿及糞尿，安排腹部電腦斷層及腸胃道鋇劑攝影均顯示迴腸膀胱廔管。後續安排住院接受剖腹探查、廔管及迴腸切除術及膀胱修補術。病理報告顯示為迴腸憩室和潰瘍伴有急性和慢性發炎。病人於術後第7天併發膀胱出血及膀胱滲漏，經膀胱鏡清血塊及腹腔引流後，於術後第36天出院。本文討論腸道膀胱廔管的病態生理學、危險因子、常見症狀、診斷及治療、手術併發症處理等。此案例提醒基層醫師若病人有肉眼可見的血尿合併骨盆腔放射線治療的病史應鑑別診斷腸道膀胱廔管，需儘早安排腸胃道鋇劑攝影或腹部電腦斷層，以免延誤診斷時機。</p> <p> </p><p>The patient was a 75-year-old woman who presented with gross hematuria for two days. Her medical history included cervical cancer, stage IV treated with pelvic radiation therapy (RT) 10 years ago, hypertension, and type 2 diabetes mellitus. The patient visited the emergency department of our hospital on May 29, 2016, and was hospitalized for further evaluation. Cystoscopy on the 2nd day after admission revealed hemorrhagic cystitis. Transurethral resection of bladder tumor (TURBT) was performed on the 4th day after admission. The pathology report revealed acute and chronic bladder inflammation and bleeding. The patient was discharged on the 8th day after admission. However, the patient developed lower abdominal pain, gross hematuria, and fecaluria on the 10th postoperative day. Abdominal computed tomography (CT) and gastrointestinal tract (GI) series were performed, all of which showed an ileum-vesical fistula. Exploratory laparotomy, resection of the fistula and ileum, and bladder repair, were performed on June 17, 2016, fifteen days after her first operation. The surgeries were successful and uneventful. Pathological examination revealed a diverticulum and ulcer with transmural mixed acute and chronic inflammation. Unfortunately, the patient developed intraperitoneal bladder perforation on the 7th postoperative day. After adequate abdominal drainage and cystoscopy-assisted blood clot evacuation, she was discharged from the hospital on the 36th postoperative day. This article discusses the pathophysiology of enterovesical fistula, risk factors, common symptoms, diagnosis and treatment, and the management of surgical complications. Clinicians should keep this clinical scenario in mind if the patient has gross hematuria combined with a history of pelvic RT. This combination of symptoms and history should suggest a differential diagnosis of enterovesical fistula and arrangement of GI series or abdominal CT should be performed as soon as possible to avoid delaying the diagnosis.</p> <p> </p>

Transurethral resection of bladder tumors (TURBT)

Die transurethrale Resektion von Blasengewebe (TUR-B) ist für die Diagnostik und Therapie bei Blasentumoren indiziert. Diese werden fragmentiert mittels diathermaler Schlinge abgetragen. Der Wundgrund wird zur Blutstillung koaguliert. Zu achten ist auf eine ausreichende Schnitttiefe, sodass die Detrusormuskulatur erfasst ist. Postoperativ kann zur Rezidivprophylaxe eine intravesikale Single-shot-Chemotherapie verabreicht werden. Methoden zur verbesserten Tumorvisualisation (insbesondere photodynamische Diagnostik) helfen, besonders bei multilokulärem Befund oder Carcinoma in situ (CIS) bessere Detektionsraten zu erreichen sowie das Rezidiv- und Progressionsrisiko zu senken. In Abhängigkeit von der Histologie ergibt sich das weitere Vorgehen: bei nicht muskelinvasivem Blasenkarzinom Nachsorge, adjuvante Instillationstherapie mittels Chemotherapie oder Bacillus Calmette-Guérin (BCG), die Nachresektion („second look TUR-B“), die Frühzystektomie oder bei muskelinvasivem Blasenkarzinom die Zystektomie oder (onkologisch nachrangig) die trimodale Therapie mit erneuter TUR‑B, Radiotherapie und Chemotherapie. Mögliche Komplikationen im Rahmen der TUR‑B sind v. a. Nachblutung mit Blasentamponade, extra- oder intraperitoneale Blasenperforation oder Infektionen des Urogenitaltrakts.

Postpartum Gangrenous Cystitis with Intraperitoneal Bladder Perforation: A Case Report and Review of the Literature

Postpartum gangrenous cystitis is a rare condition with only a few reported cases in the literature. We report a case of a 26-year-old lady who developed gangrenous cystitis and perforation 48 hours after a prolonged labour when she presented in urinary retention and sepsis. Computerised Tomography (CT) scans revealed ascites. With clinical signs of peritonitis, emergency diagnostic laparoscopy was performed, identifying the bladder perforation. The procedure was converted to laparotomy and necrotic bladder tissue was excised and bladder was repaired. We highlight the important learning points from the case and review the current literature on aetiology, diagnostic challenges and management of this rare complication.

Efficacy of the Treatment of Intraperitoneal Bladder Perforation during Transurethral Resection of Bladder Tumor with the Urethral Catheter Alone: Retrospective Analysis of over 15 Years Using the Clinical Data Warehouse System

Introduction: We investigated the efficacy of a urethral catheter alone for intraperitoneal perforation during transurethral resection of bladder tumor (TURBT). Patients and Methods: We retrospectively evaluated the medical records of 4,543 patients who underwent TURBT from January 2000 to December 2017 using the Clinical Data Warehouse system. The clinicopathologic characteristics, recurrence-free survival, and progression-free survival were compared between the patient groups with intraperitoneal perforation treated with the Foley catheter alone, extraperitoneal perforation, and matched control TURBT. Results: Intraperitoneal perforation and extraperitoneal perforation were observed in 16 (35.6%) and 29 (64.4%) patients, respectively. In the intraperitoneal perforation group, 11 (68.8%), 2 (12.5%), and 3 (18.8%) patients were treated with the Foley catheter alone, additional percutaneous drainage, and delayed open surgery, respectively. The use of the Foley catheter alone in patients with intraperitoneal perforation of smaller size than the cystoscope or no pelvic radiotherapy history showed improved efficacy without sequelae or therapeutic delay. One of the 2 patients with the size of the intraperitoneal perforation larger than the cystoscope was successfully treated with the Foley catheter alone, whereas the other patient underwent delayed surgical repair. There was no difference in recurrence-free survival and progression-free survival of the intraperitoneal perforation treated with the Foley catheter alone compared to those of the matched control TURBT (p = 0.909, p = 0.518) and the extraperitoneal perforation (p = 0.458, p = 0.699). Conclusions: Intraperitoneal perforation rarely occurred during TURBT. In the case of intraperitoneal perforation of size smaller than cystoscopy or without pelvic radiotherapy history, treatment with the Foley alone showed successful improvement and safe oncological results. Therefore, treatment with the urethral catheter alone can be carefully considered when an intraperitoneal perforation smaller than the cystoscope size or without pelvic radiotherapy history occurs.

Bladder perforation during transurethral resection of the bladder: a comprehensive algorithm for diagnosis, management and follow-up

Despite bladder perforation (BP) is a frequent complication during transurethral resection of bladder (TURB) for bladder cancer (BCa), literature lacks systematic reviews focusing on this issue. We aimed to investigate incidence, diagnosis, therapy, and prognosis after BP during TURB for BCa; therapy was distinguished between conservative (without the need for bladder repair) and surgical management (requiring bladder wall closure). A systematic search was conducted up to April 2021 using PubMed, Scopus, Cochrane Database of Systematic Reviews, and Web of Science to identify articles focusing on incidence, detection, management, or survival outcomes after iatrogenic BP. The selection of articles followed the preferred reporting items for systematic review and meta-analyses process. We included 41 studies, involving 21,174 patients. Overall, 521 patients experienced BP during TURB for BCa, with a mean incidence of 2.4%, up to 58.3% when postoperative cystography is routinely performed after all TURB procedures. Risk factors were low body mass index (BMI) (P=0.01), resection depth (P=0.006 and P=0.03), and low surgical experience (P=0.006). Extraperitoneal BP (68.5%) were treated conservatively in 97.5% of patients; intraperitoneal BP were managed with surgical bladder closure in 56% of cases. Overall, three immediate BP-related deaths were recorded due to septic complications. Extravesical tumor seeding was observed after 6 intraperitoneal and 1 extraperitoneal BP (median time: 6.2 months). Intraperitoneal BP (P=0.0003) and bladder closure (P<0.001) were found as independent predictors of extravesical tumor recurrence. BP is more frequent than expected when proper diagnosis is routinely performed after all TURB procedures. Risk factors include low BMI, resection depth, and unexperienced surgeon. The risk of sepsis after BP suggests empirical antibiotic prophylaxis after BP.

Intraperitoneal bladder perforation after routine urethral catheterisation

Intraperitoneal bladder perforation after routine urethral catheterisation

Conservative Management of Intraperitoneal Urinary Bladder Perforation with Enterovesical Fistula

Conservative Management of Intraperitoneal Urinary Bladder Perforation with Enterovesical Fistula

Intraperitoneal Urinary Bladder Perforation with Pneumoperitoneum in Association with Indwelling Foley Catheter Diagnosed in Emergency Department

BackgroundIndwelling Foley catheter is a rare cause of urinary bladder perforation, a serious injury with high mortality that demands accurate and prompt diagnosis. While the gold standard for diagnosis of bladder injury is computed tomography (CT) cystography, few bladder ruptures associated with Foley catheter have been reported to be diagnosed in the emergency department (ED). Case ReportAn 83-year-old man with indwelling Foley catheter presented to the ED for hematuria and altered mental status. He was diagnosed to have intraperitoneal rupture of the urinary bladder in the ED using abdominal and pelvic CT without contrast, which demonstrated bladder wall discontinuity, intraperitoneal free fluid, and pneumoperitoneum. The patient was treated successfully with medical management and bladder drainage. Why Should an Emergency Physician Be Aware of This?To our knowledge, this is the first report of intraperitoneal urinary bladder perforation associated with Foley catheter diagnosed in the ED by CT without contrast. Pneumoperitoneum found in this case was a clue to the diagnosis and is a benign finding that does not necessitate urgent surgical intervention. The early and accurate diagnosis in this case allowed for effective management with good clinical outcome. The use of indwelling Foley catheter has a high prevalence, especially in long-term care facility residents, who are frequent visitors in the ED. Therefore, emergency physicians and radiologists should be familiar with the presentation and imaging findings of this potential injury associated with Foley catheters.

Spontaneous rupture of the bladder during vomiting

A 46-year-old woman with no urological history or comorbidities presented with an acute abdomen with haematuria after a spell of protracted vomiting. The initial cystogram was negative; however, CT imaging...

Intraperitoneal Bladder Perforation Due to Clean Intermittent Catheterization: A Case Report and Literature Review

Intraperitoneal Bladder Perforation Due to Clean Intermittent Catheterization: A Case Report and Literature Review

Intraperitoneal Bladder Perforation and Life-threatening Renal Failure in a Neonate Following Circumcision With the Plastibell Device

We present the case of an infant who suffered intraperitoneal bladder perforation secondary to routine neonatal circumcision with the Plastibell device. On day-of-life 5, the patient presented with abdominal distention, vomiting, diarrhea, and severe acute renal failure. After removal of a distal meatal obstruction caused by the Plastibell device and open repair of the bladder defect, the patient had an uneventful recovery with rapid return of renal function. Despite the relative safety of the Plastibell, this case underscores the importance of careful device placement, parental education, keen clinical judgment, and prompt intervention when indicated.

Rhabdomyolysis and acute renal failure following transurethral resection of bladder tumor

s / Urological Science 26 (2015) S50eS81 S80 Results: There were 6 patients in intraperitoneal group and 6 patients in extraperitoenal group with a mean age of 44.5 and 43.2 in each group. Mechanisms of injury were blunt abdominal trauma and pelvic fracture. There was no significant difference between the IBP and EBP groups with regard to age, mechanism of injury, baseline creatinine and blood urea nitrogen (BUN). The biochemical parameters were found to be within normal range in the EBP group, whereas significantly higher levels of creatinine, BUN were noted in IBP group (p 1⁄4 0.01 and 0.06) Conclusion: In patients with intraperitoneal bladder perforation, progressive urinary ascites with the development of abdominal discomfort will soon follow. This is because the excretion function of the kidney greatly exceeds the subdiaphragmatic lymph flow, which provides the principal means for the removal of intraperitoneal fluid. Stasis of urine in the peritoneal cavity allows for reversed intraperitoneal autodialysis to take place. The higher concentration of creatinine and nitrogenous waste products in the urine as compared to plasma allows for concentration gradient diffusion when the urine is in contact with the peritoneum, functioning as a semipermeable membrane. As illustrated in this study, the patient's serum creatinine and BUN will rise. But because the glomerular filtration rate is intact, the raise of serum creatinine is referred to as pseudorenal failure. When pseudorenal failure based on reversed autodialysis is suspected, the intraperitoneal bladder perforation should be considered in differential diagnosis. Further study such as cystography is warranted in these patient and it can identifies a bladder tear by documenting intraperitoneal contrast leakage. patients presenting with IBP are more likely to present with significantly higher levels of creatinine and BUN compared with the patients with EBP. Biochemical alterations can be used to differentiate traumatic IBP and EBP with subtle physical examination and radiological findings. NDP115: RHABDOMYOLYSIS AND ACUTE RENAL FAILURE FOLLOWING TRANSURETHRAL RESECTION OF BLADDER TUMOR Jen-Hao Cheng, Cheng-Che Chen, Yen-Chuan Ou. Divisions of Urology, Department of Surgery, Taichung Veterans General Hospital, Taichung,

Serum creatinine for differentiating traumatic intraperitoneal and extraperitoneal bladder perforation

以血中肌肝酸濃度來分別創傷性腹腔內外膀胱破裂 高正立 高建璋 曹智惟 唐守宏 蒙恩 吳勝堂 查岱龍 于大雄 張聖原 孫光煥 1 高建璋 1 三軍總醫院 外科部 泌尿外科 ,國軍桃園總醫院 外科部 泌尿外科 ;台北市立聯 合醫院 泌尿科 3 Serum creatinine for differentiating traumatic intraperitoneal and extraperitoneal bladder perforation Cheng-Li Kao 1,2 , Chien-Chang Kao 1 , Chu-Wei Tsao 1 , Shou-Hung Tang 1 , En Meng 1 , Sheng-Tang Wu 1 , Tai-Lung Cha 1 , Dah-Shyong Yu 1 , Sun-Yran Chang 3 , Guang-Haun Sun 1 ,Chien-Chang Kao 1 Guang-Haun Sun 1

Intraperitoneal Urinary Bladder Perforation Observed in a Patient with an Indwelling Urethral Catheter

This report describes a rare case of an 86-year-old man with an indwelling urethral catheter who developed severe abdominal pain and was diagnosed with intraperitoneal urinary bladder perforation. A home-visiting nurse suspected catheter obstruction and performed a catheter exchange. However, bladder irrigation could not subsequently be performed. Computed tomography of the abdomen and pelvis after transurethral perfusion of contrast medium demonstrated extravasation of the contrast material into the peritoneal cavity. Furthermore, the Foley catheter balloon was positioned in the peritoneal cavity through the bladder. The patient was diagnosed with peritonitis due to spontaneous intraperitoneal perforation of the urinary bladder, and exploratory laparotomy was performed. During exploration, a perforated tear at the top of the bladder was discovered where the Foley catheter had penetrated the bladder. The Foley catheter balloon was floating freely in the peritoneal cavity. There was no evidence of pathologic lesions, such as cancer or inflammatory mass at the site of the injured peritoneum. Successful closure of the damaged peritoneum and bladder was performed. Since the proportion of elderly individuals continues to increase in the general Japanese population, the incidence of the chronic Foley catheterization is expected to increase. Therefore, clinicians should be aware of this potential complication.

Laparoscopic repair of iatrogenic bladder perforation during transurethral bladder tumor resection: Case report and literature review

An intraperitoneal bladder perforation occurred during transurethral tumor resection under general anesthesia in a 82 year old woman. The bladder was repaired with a laparoscopic closure and an indwelling urethral catheter. The histopathology revealed T1 high grade urothelial carcinoma. The patient recovered well and was discharged home on postoperative day 7. This case highlights the successful use of laparoscopy in the treatment of a rare urological complication.

Micropapillary carcinoma of the bladder presented with spontaneous intraperitoneal bladder rupture

Spontaneous bladder perforation is a rare presenting feature of bladder malignancy. We describe an unusual case of a patient, admitted to emergency, with diffuse abdominal pain due to spontaneous bladder rupture in association with a micropapillary carcinoma. A diagnosis of an intraperitoneal bladder perforation was made during an emergency operation. Aspects of etiology, clinical presentation, diagnosis and management are described. Although cases of spontaneous carcinomatous bladder rupture are associated with high morbidity and mortality, prompt identification and treatment can lead to favourable outcomes.

Micropapillary carcinoma of the bladder presented with spontaneous intraperitoneal bladder rupture

Spontaneous bladder perforation is a rare presenting feature of bladder malignancy. We describe an unusual case of a patient, admitted to emergency, with diffuse abdominal pain due to spontaneous bladder rupture in association with a micropapillary carcinoma. A diagnosis of an intraperitoneal bladder perforation was made during an emergency operation. Aspects of etiology, clinical presentation, diagnosis and management are described. Although cases of spontaneous carcinomatous bladder rupture are associated with high morbidity and mortality, prompt identification and treatment can lead to favourable outcomes.