Spontaneous Bladder Rupture Research Articles

Spontaneous Bladder Rupture Diagnosed by Pleural Fluid Analysis

Spontaneous Bladder Rupture Diagnosed by Pleural Fluid Analysis

Spontaneous Rupture of the Urinary Bladder - A Case Report and Review of Literature

Introduction: Spontaneous rupture of the urinary bladder [SRUB] is a rare event. Patients usually present with features of peritonitis and diagnosis is usually made at operation. There are several factors that can predispose patients to an event like this, but most commonly it includes a chronic increase in bladder wall pressure and chronic inflammatory states besides malignancy. Case Report: A 42 years old male came in emergency surgery department with pain in abdomen. Ultrasonography of abdomen was suggestive of peritonitis for which he underwent exploratory laparotomy and was found to have perforation of urinary bladder which was repaired. Patient recovered uneventfully. Conclusion: Rupture of urinary bladder must be included in the differential diagnosis of acute abdomen presenting with peritonitis. A high index of suspicion is essential in the presence of urinary symptoms. In the majority of cases, underlying bladder pathology has been identified, although idiopathic SRUB may occur.

Postvoid abdominal pain may be a symptom of spontaneous bladder rupture

Postvoid abdominal pain may be a symptom of spontaneous bladder rupture

Spontaneous bladder rupture in non-augmented bladder exstrophy

Bladder perforation is not commonly described in bladder exstrophy patients without bladder augmentation. The goal of this study was to identify the risk factors of spontaneous perforation in non-augmented exstrophy bladders. The study was a retrospective multi-institutional review of bladder perforation in seven male andtwo female patients with classic bladder exstrophy-epispadias (E-E). Correction of E-E was performed using Kelly repair in two and staged repair in seven (Table). Bladder neck repair was performed in eight patients at a mean age of 6 years. Three patients had additional urethral surgery. Before rupture, six patients were voiding only per urethra. Two patients were voiding urethrally but were also performing occasional CIC via a Mitrofanoff. One patient was performing CIC 3 hourly per urethra. Six were dry during the day. Six of the patients had lower urinary tract symptoms: five had frequency and four were straining to void. Two had suffered episodes of urinary retention. Pre-rupture ultrasound showed that the upper urinary tract was dilated in four patients. Micturating cystourethrogram was performed in six showing vesico-ureteral reflux in five. Two had urethral stenosis. Nuclear medicine was done in three patients with two abnormal differential function. Urodynamics was performed in two patients with low capacity (100mL) and hypocompliant (<10) bladders. Both had high leak point pressures: 60 cmH2O at 100mL. The mean age at rupture was 11 years, with a range of 5-20 years. Patients presented with abdominal pain, associated with signs of intestinal obstruction in seven and fever in two. Eight patients underwent laparotomy and one prolonged drainage via SPC. Simple closure was performed in seven and bladder neck closure in one, because of extension of the rupture inferiorly. All patients recovered well. Following rupture, five underwent augmentation and Mitrofanoff. One of these suffered a recurrent rupture. Two other patients refused augmentation and Mitrofanoff and one of these has since had a subsequent rupture. The limitations of this series include the small number of patients and its retrospective nature, without knowledge of the incidence. Bladder rupture is a risk even in non-augmented bladder exstrophy. It is potentially life-threatening and most often requires laparotomy. Rupture occurs because of poor bladder emptying and/or high pressure. Urodynamics may identify those at risk. CIC with or without augmentation should not be delayed once poor bladder emptying and/or high pressure are identified.

Spontaneous Rupture of Urinary Bladder in a Young Alcoholic Male

Spontaneous rupture of the urinary bladder (SRUB) is a rare clinical condition. Prompt diagnosis is often difficult both clinically and radiologically and necessitates a high index of suspicion as the patients present with non-specific abdominal pain and may not offer a clear history. We report this young male who presented with SRUB which occurred after alcohol intoxication and presented to us with vague abdominal pain, anuria, and intraperitoneal fluid collection. He had presented with a painful urinary retention few days prior to this visit, was catheterized temporarily and was discharged on antibiotics with a diagnosis of prostatitis. Currently, he stated that he had not urinated since the recent discharge, and noticed increasing abdominal distension. He also had diffuse severe abdominal pain. Patient stated that prior to this, he had consumed 12 beers. Examination revealed a male in acute distress, with normal ranges vital signs. Abdomen was soft, diffusely tender, with sluggish bowel-sounds, and no rebound-tenderness. Rest of examination was normal. Blood workup was significant for elevated BUN and creatinine from his baseline, and leukocytosis. A Foley catheter was placed. His abdomen computed tomography (CT) scan showed a newly developed pneumoperitoneum. CT cysto-urethrogram confirmed intraperitoneal bladder rupture. The patient had an exploratory laparotomy. The bladder defect was closed, and an indwelling catheter was left to ease healing. He had an uneventful postoperative course, and was discharged with a follow-up appointment in the urology clinic. Spontaneous urinary-bladder rupture is a rare event. Excessive alcohol consumption causes diuresis, over-distension and rupture of the urinary bladder. Initial presentation remains imprecise; continuous urinary leakage leads to abscesses, sepsis, and metabolic derangements. CT scan is imaging modality of choice. The condition is a surgical emergency, and necessitates laparotomy and closure of the breach. J Med Cases. 2016;7(6):245-247 doi: http://dx.doi.org/10.14740/jmc2470w

Long-term complications following bladder augmentations in patients with spina bifida: bladder calculi, perforation of the augmented bladder and upper tract deterioration.

BackgroundWe desire to review our experience with bladder augmentation in spina bifida patients followed in a transitional and adult urologic practice. This paper will specifically focus on three major complications: bladder calculi, the most frequent complication found following bladder augmentation, perforation of the augmentation, its most lethal complication and finally we will address loss of renal function as a direct result of our surgical reconstructive procedures.MethodsWe reviewed a prospective data base maintained on patients with spina bifida followed in our transitional and adult urology clinic from 1986 to date. Specific attention was given to patients who had developed bladder calculi, sustained a spontaneous perforation of the augmented bladder or had developed new onset of renal scarring or renal insufficiency (≥ stage 3 renal failure) during prolonged follow-up.ResultsThe development of renal stones (P<0.05) and symptomatic urinary tract infections (P<0.0001) were found to be significantly reduced by the use of high volume (≥240 mL) daily bladder wash outs. Individuals who still developed bladder calculi recalcitrant to high volume wash outs were not benefited by the correction of underlying metabolic abnormalities or mucolytic agents. Spontaneous bladder perforations in the adult patient population with spina bifida were found to be directly correlated to substance abuse and noncompliance with intermittent catheterization, P<0.005. Deterioration of the upper tracts as defined by the new onset of renal scars occurred in 40% (32/80) of the patients managed by a ileocystoplasty and simultaneous bladder neck outlet procedure during a median follow-up interval 14 years (range, 8–45 years). Development of ≥ stage 3 chronic renal failure occurred within 38% (12/32) of the patients with scarring i.e., 15% (12/80) of the total patient population. Prior to the development of the renal scarring, 69% (22/32) of the patients had been noncompliant with intermittent catheterization. The onset of upper tract deterioration (i.e., new scar formation, hydronephrosis, calculus development, decrease in renal function) was silent, that is, clinically asymptomatic in one third (10/32 pts).ConclusionsThis paper documents the need for high volume bladder irrigations to both prevent the most common complication following bladder augmentation, which is the development of bladder calculi and to reduce the incidence of symptomatic urinary tract infections. It provides a unique perspective regarding the impact of substance abuse and patient non-compliance with medical directives as being both the most common cause for both spontaneous bladder rupture following augmentation cystoplasty and for deterioration of the upper tracts. These findings should cause the surgeon to reflect on his/her assessment of a patient prior to performing a bladder augmentation procedure and stress the need for close follow-up.

Spontaneous Rupture of Urinary Bladder in a Young Alcoholic Male

Spontaneous Rupture of Urinary Bladder in a Young Alcoholic Male

A Case of Spontaneous Urinary Bladder Rupture

A Case of Spontaneous Urinary Bladder Rupture

Computed Tomography Manifestations of Spontaneous Bladder Rupture Associated with Alcohol Bingeing

Computed Tomography Manifestations of Spontaneous Bladder Rupture Associated with Alcohol Bingeing

Spontaneous rupture of the bladder: Report of two cases

To report two cases of spontaneous urinary bladder rupture following binge-drinking. Two male patients with history of alcohol abuse and no history of trauma, presented with progressive abdominal distension and features of peritonitis. In both cases. exploratory laparotomy revealed intraperitoneal rupture of the bladder. Primary repair was performed which was followed by an uneventful recovery. Spontaneous rupture of the bladder is a rare occurrence and when encountered, it presents a diagnostic challenge. A diagnosis of spontaneous perforation of the bladder should be considered in alcoholic patients presenting with an acute abdomen in a relatively stable condition and blood biochemistry showing a disproportionately elevated urea and creatinine.

Urinary Ascites

Introduction: Atraumatic bladder rupture is a rare occurrence and therefore not considered highly on the differential for a patient who presents with new onset ascites. We present this case to show the complexity of diagnosing and managing ascites secondary to bladder rupture. Case Report: A 43 year-old female with untreated multiple sclerosis (MS) presented with abdominal pain beginning immediately after voiding. Initial labs revealed mild leukocytosis with normal liver function, creatinine and lipase. Contrast tomography (CT) abdomen/pelvis showed large ascites with normal appearing liver. Pelvic ultrasound demonstrated a small left paraovarian cyst. General surgery and gynecology ruled out acute abdomen, thought the presentation was due to ruptured ovarian cyst and recommended conservative management. Paracentesis fluid was concerning for secondary bacterial peritonitis with labs showing serum albumin-ascites gradient of > 1.1, white blood cell count of 3610, polymorphonuclears of 88%, total protein of 1.3, glucose of 36, and creatinine of 8.27. Five days later, the patient started to have worsening abdominal pain, leukocytosis and renal function. Repeat CT of the abdomen/pelvis showed a marked increase in abdominal ascites as well as an abnormality of the bladder wall that likely represented a bladder diverticulum, but a bladder wall rupture or diverticular rupture could not be excluded. Cystogram confirmed bladder rupture which was thought to be from obstructive uropathy secondary to neurogenic bladder from her untreated MS. She failed conservative management with increased abdominal pain and ileus and subsequently underwent a cystoscopy, cystorrhaphy, and diverticulectomy with drain placement. Discussion: While traumatic rupture of the bladder is a more common occurrence, ascites secondary to a spontaneous bladder rupture is a rare occurrence, documented sparsely in case reports. Due to the delay in diagnosis, patients have poorer outcomes and a high mortality rate. A PubMed search found two other cases of bladder rupture in MS patients, but unlike our patient they presented with signs of acute abdomen. Conclusion: Perforated urinary bladder should be considered in the differential diagnoses in patients presenting with new onset ascites and acute kidney injury without any evidence of chronic liver or heart disease or any other common causes of ascites. Early diagnosis can greatly improve the patient's hospital course and overall outcome.

The role of imaging in pediatric bladder augmentation.

Bladder augmentation (also called augmentation cystoplasty) refers to a number of surgical methods that increase the capacity and compliance of the urinary bladder. Imaging has an important role in the postoperative evaluation of bladder augmentation. The most common augmentation procedures utilize enteric segments to augment the bladder. The various types of bladder augmentation have characteristic appearances on different imaging modalities. Spontaneous bladder perforation is a complication that is seen in both early and late post-operative periods and it is one of the most important complications for radiologists to be aware of as it is life-threatening. We review the indications for bladder augmentation in children, the surgical techniques employed, the normal postoperative appearances on imaging studies and the role of imaging complications of bladder augmentation including delayed spontaneous bladder rupture, which is life-threatening.

Idiopathic spontaneous rupture of the urinary bladder - A rare cause of death

Spontaneous rupture of the urinary bladder is a rare clinical condition, with a prevalence of about 1 in 126.000 hospitalizations. Idiopathic rupture is even more rarely encountered, constituting less than 1% of all cases. Given the low incidence, atypical symptoms and poor history data, the diagnosis is often established late and treatment is delayed, resulting in a high rate of mortality. Also, spontaneous rupture of the urinary bladder may be a surprise at the autopsy. In this paper, the authors present the case of a 67 years old woman who died due to idiopathic spontaneous rupture of the urinary bladder after ingestion of alcoholic beverages. The autopsy showed no signs of pathological or traumatic injury and the toxicological examination revealed a blood alcohol concentration of 2.05 g ‰. The case is analyzed in the context of existing literature data, taking into account the elements of anatomy, physiology and pathophysiology that can determine or favour the idiopathic spontaneous rupture of the urinary bladder.

Investigation of Patients with Spontaneous Rupture of the Urinary Bladder

Non-traumatic rupture of the urinary bladder is termed “spontaneous rupture of the urinary bladder”. Although this disorder is relatively rare, when the bladder ruptures into the abdominal cavity, urine leaking into the abdominal cavity leads to the development of urinary peritonitis. We encountered seven patients with spontaneous rupture of the urinary bladder at our institution between 1987 and 2012. Six of these patients were women, all of whom had undergone surgery and radiotherapy to treat malignant uterine tumor. All seven patients suddenly developed abdominal pain and ascites. Urea nitrogen (UN) and creatinine (Cre) levels were greater in ascites than in the blood in all patients. Although all patients were treated conservatively, recurrence was identified in three patients. Recurrence was observed in only one of the four patients who received hyperbaric oxygen therapy. Conclusion: Hyperbaric oxygen therapy may be effective for recurrence of spontaneous rupture of the urinary bladder.

Spontaneous rupture of the urinary bladder in the third trimester of pregnancy

Spontaneous rupture of the urinary bladder is defined as rupture of the urinary bladder into the peritoneal cavity without a history of trauma 1. Aetiological factors implicated include but are not limited to radiotherapy, chronic infective diseases like tuberculosis, necrotizing cystitis and in pregnancy, bladder injuries caused in the event of uterine rupture 2. Its incidence is 1 in 126,000 hospital admissions 3. We report a rare case of spontaneous intraperitoneal rupture of the urinary bladder in the early third trimester of pregnancy. This report highlights the diagnostic challenges obstetricians and surgeons may encounter with presentations of acute abdomen in pregnancy. The patient presented with acute abdominal pain, voiding difficulty with pyrexia and features of peritonitis. At laparotomy, 3.5 litres of urine were drained from the abdominal cavity and a 6cm rent in the vault of the bladder was found. Laparotomy, bladder repair with antibiotic cover and indwelling catheterization were the basis for a favourable outcome.

Pseudo-Renal Failure with Severe Hyponatremia due to Spontaneous Bladder Rupture

Spontaneous bladder rupture is rare. Such an occurrence may appear similar to renal failure because the resulting urine leakage into the peritoneal cavity and absorption across the peritoneum increases serum creatinine although glomerular filtration rate is normal. A 46-year-old man presented with abdominal distension for 7 days after consuming a large volume of alcohol. Initial laboratory tests showed a blood urea nitrogen level of 174.3 mg/dL, serum creatinine of 11.49 mg/dL, and serum sodium of 105 mmol/L. Abdominal distension resolved after draining 5,200 mL of urine through a bladder catheter. Computed tomography cystography revealed intraperitoneal leakage of contrast dye from the left dome of the bladder, suggesting an intraperitoneal bladder rupture. Azotemia was completely normalized on the third day of hospitalization. This case shows that pseudo-renal failure should be considered when caring for a patient with unexplained azotemia and ascites. (Korean J Med 2015;89:102-106)

Acute abdomen caused by spontaneous perforation of the urinary bladder in childhood: Report of one case

Spontaneous urinary bladder rupture in children is a very rare clinical occurrence that can be life threatening if left untreated. Patients usually present with symptoms of peritonitis and the correct diagnosis is usually made at surgery. Here, we present a case of spontaneous bladder perforation that was operated with a diagnosis of acute abdomen. No etiological factor for bladder perforation was found, and after the operation, the patient experienced no further problems.

Spontaneous Rupture of Urinary Bladder (SRUB) in a Young Male, Presenting as Anuria – A Case Report and Review of Literature

Spontaneous rupture of urinary bladder is a rare condition. Most of the bladder ruptures occur in association with blunt or penetrating injuries to the lower abdomen. Most often, a vague lower abdominal pain is the mode of presentation. Rarely patients present with oliguria, anuria, uremia or urosepsis. A forty year old male, under the influence of alcohol, presented with lower abdominal pain and anuria for two days with abnormal renal function. He denied history of blunt trauma. He was diagnosed to have an intra-peritoneal rupture of urinary bladder. He underwent emergency laparotomy with repair of bladder rupture. This case report illustrates the need for a high index of clinical suspicion. Prompt diagnosis and appropriate management will help in preventing a poor clinical outcome in patients with spontaneous bladder perforation. If left untreated or if there is a considerable delay in diagnosis and intervention, it usually is associated with a high morbidity.

Recurrent Spontaneous Rupture of the Urinary Bladder in a Patient With Human T-lymphotropic Virus Type 1-Associated Myelopathy: A Case Report and Literature Review

Recurrent spontaneous rupture of the urinary bladder has rarely been reported in English articles. This condition may be difficult to diagnosis before a laparotomy due to acute peritonitis. Herein we describe a case of recurrent spontaneous rupture of the bladder in a 39-year-old woman with human T-lymphotropic virus type 1 (HTLV-1) -associated myelopathy/topical spastic paraparesis (HAM/TSP).

Spontaneous bladder rupture in acute alcohol intoxication

Spontaneous bladder rupture is a rare condition that can be followed by an acute alcohol intoxication and can be associated with significant morbidity and mortality. We report a case diagnosed in a alcoholic young male who was admitted to our emergency room for epigastric pain. The case demonstrates the difficulties with diagnosis and the need for physicians who work in an emergency room to be aware of this condition.