Electrolyte Blood Press.  2014 Jun;12(1):26-29. 10.5049/EBP.2014.12.1.26.

A Case of Post-radiotherapy Urethral Stricture with Spontaneous Bladder Rupture, Mimicking Obstructive Uropathy due to Cancer Metastasis

• Shin JY
• Yoon SM
• Choi HJ
• Lee SN
• Kim HB
• Joo WC
• Song JH
• Kim MJ
• Lee SW

• KMID: 1708554
• DOI: http://doi.org/10.5049/EBP.2014.12.1.26

Abstract

Non-traumatic, spontaneous urinary bladder rupture is a rare complication of urethral stricture. Furthermore, its symptoms are often nonspecific, and misdiagnosis is common. The authors experienced a case of urethral stricture with spontaneous bladder rupture and bilateral hydronephrosis, mimicking obstructive uropathy attributed to cancer metastasis. A 55-year-old woman was admitted with abdominal pain and distension, oliguria, and an elevated serum creatinine level. She had undergone radical hysterectomy for uterine cervical cancer and received post-operative concurrent chemoradiation therapy 13 years previously. Non-contrast enhanced computed tomography showed massive ascites and bilateral hydronephrosis. The initial diagnosis was acute kidney injury due to obstructive uropathy caused by malignant disease. After improvement of her renal function by bilateral percutaneous nephrostomy catheterization, contrast-enhanced computed tomography and a cytologic examination of ascites showed no evidence of malignancy. However, during retrograde pyelography, a severe urethral stricture was found, and subsequent cystography showed leakage of contrast into the peritoneal cavity and cystoscopy revealed a defect of the posterior bladder wall. After urethral dilatation and primary closure of the bladder wall, acute kidney injury and ascites were resolved.

Keyword

Acute kidney injury; Urinary bladder; Spontaneous rupture; Hydronephrosis; Radiotherapy

MeSH Terms

Abdominal Pain
Acute Kidney Injury
Ascites
Catheterization
Catheters
Creatinine
Cystoscopy
Diagnosis
Diagnostic Errors
Dilatation
Female
Humans
Hydronephrosis
Hysterectomy
Middle Aged
Neoplasm Metastasis*
Nephrostomy, Percutaneous
Oliguria
Peritoneal Cavity
Radiotherapy
Rupture*
Rupture, Spontaneous
Urethral Stricture*
Urinary Bladder*
Urography
Uterine Cervical Neoplasms
Creatinine

Figure

• 

  Fig. 1 Abdomen-pelvic CT images. Transverse (A) and coronal (B) sections show bilateral hydroureteronephrosis without definite Obstructive lesion or stone. (C) show diffuse thickened urinary bladder Wall.

• 

  Fig. 2 Cystography. AP (A) and lateral view (B) of cystography show contrast leakage to peritoneal cavity without demonstration of fistular tract.

Reference

1. Saleem MA, Mahmoud AM, Gopinath BR. Spontaneous urinary bladder rupture: a rare differential for lower abdominal pain in a female patient. Singapore Med J. 2009; 50:e410–e411. PMID: 20087542.

2. Limon O, Unluer EE, Unay FC, Oyar O, Sener A. An unusual cause of death: spontaneous urinary bladder perforation. Am J Emerg Med. 2012; 30:2081.e3–2081.e5. PMID: 23158061.

3. Albrecht K, Günther D, Oelke M, Wilke N, Wagner C, Törger HD. Spontaneous rupture of the urinary bladder. Arch Kriminol. 2004; 213:154–164. PMID: 15328924.

4. Basavaraj DR, Zachariah KK, Feggetter JGW. Acute abdomen - remember spontaneous perforation of the urinary bladder. J R Coll Surg Edinb. 2001; 46:316–317. PMID: 11697704.

5. Lowe FC, Fishman EK, Oesterling JE. Computerized tomography in diagnosis of bladder rupture. Urology. 1989; 33:341–343. PMID: 2929071.

6. Albino G, Bilardi F, Gattulli D, Maggi P, Corvasce A, Marucco EC. Spontaneous rupture of urinary bladder: a case report and review. Arch Ital Urol Androl. 2012; 84:224–226. PMID: 23427749.

7. Lee MH, Jung JY, Baek DH, et al. A case of spontaneous-bladder rupture after a bout of heavy drinking. Korean J Med. 2009; 76:370–373.

8. Park JW. A case of peritonitis induced by urinary ascites due to spontaneous intraperitoneal bladder rupture. J Korean Geriatr Soc. 2011; 15:230–233.

9. Dubey IB, Mohanty D, Jain BK. Diverse presentation of spontaneous rupture of urinary bladder: review of two cases and literature. Am J Emerg Med. 2012; 30:832.e1–832.e3. PMID: 21570232.

10. Fujikawa K, Miyamoto T, Ihara Y, Matsui Y, Takeuchi H. High incidence of severe urologic complications following radiotherapy for cervical cancer in Japanese women. Gynecol Oncol. 2001; 80:21–23. PMID: 11136564.

11. Elliott SP, Bahaa SM. Long-term urinary adverse effects of pelvic radiotherapy. World J Urol. 2011; 29:35–41. PMID: 20959990.

12. Lynn SJ, Mark SD, Searle M. Idiopathic spontaneous bladder rupture in an intoxicated patient. Clin Nephrol. 2003; 60:430–432. PMID: 14690262.