Bladder necrosis: ‘A man without a bladder’

Abstract

Since the use of antibiotics, bladder necrosis has become a rare condition. We report a case of bladder necrosis in a 90-year-old man following urinary retention. After insertion of a transurethral catheter (TUC), 2 L of urine was evacuated. In the following days, the TUC became intermittently blocked. Adequate bladder drainage could not be obtained despite intensive rinsing and placement of a suprapubic catheter. On surgical exploration necrosis of almost the entire bladder wall, except for the trigone, was encountered. Surgical debridement of the non-viable bladder wall without opening the abdominal cavity was conducted, and a TUC was placed in the Retzius cavity to ensure evacuation of urine. Since the patient was haemodynamically unstable, construction of a urinary diversion was waived and urinary drainage of the Retzius cavity by the TUC was accepted, resulting in adequate urinary drainage without compromising renal function.

Gangrenous Cystitis Secondary to a Spontaneous Hematoma of the Lesser Pelvis

“…The conservative approach, involving appropriate antibiotic therapy and the sealing of the urinary bladder, is often effective [10]. Surgical intervention is required in more advanced cases, where the patient undergoes either a radical or partial cystectomy with the preservation of the trigone [2,11,12].…”

Peritonitis aguda secundaria a cistitis gangrenosa posparto

“…Estas causas incluyen agentes intravesicales, radiación pélvica e infecciones sistémicas severas. Los microorganismos formadores de gas han sido implicados en los casos de pacientes con diagnóstico de diabetes mellitus no controlada (7)(8)(9)(10)(11) .…”

“…El tratamiento quirúrgico debe ser temprano y agresivo e incluye desbridamiento extenso de las porciones necróticas de la vejiga. En la mayoría de los casos, el trígono permanece viable (esta porción anatómica está irrigada adicionalmente por ramas arteriales que irrigan los uréteres) y, en consecuencia, rara vez es necesaria la cistectomía total con derivación urinaria (7,8) . Después de la resolución del cuadro clínico, es posible intentar la regeneración vesical (8,9,12) .…”

Gangrenous Cystitis: A Rare Case Report

“…Most reported cases were published a few decades ago when the use of antibiotics was not as prevalent as today. With the widespread use of antibiotics, gangrenous cystitis has become a rarely reported pathology [2].…”