Catastrophic Haemorrhage From the Bladder Due to Unrecognised Secondary Amyloidosis

Abstract

SUMMARY We report the cases of a 41‐year‐old man, who died of severe and intractable hzmorrhage from the urinary bladder, and of a 55‐year‐old woman in whom such hzmorrhage ushered fatal urzmia. He had suffered from severe ankylosing spondylitis with involvement of proximal limb‐joints for 14 years, and she from severe rheumatoid disease for 20 years with episodes superimposed pyogenic arthritis during the last 3 months. Both had widespread secondary amyloidosis, unrecognised in life, with severe involvement of the blood‐vessels of the vesical submucosa‐the source of the hzmorrhage‐and of the kidneys. Factors probably contributing to the initiation of bleeding were severe hypertension in the man, septicremia (Streptococcus pyogenes) and prolonged hypotension in the woman, and a considerable degree of renal failure both. It is suggested that—whenever exploratory cystotomy fails to reveal the cause of continuing bleeding from the bladder—a sample of the vesical wall should be submitted to microscopy.

Amyloidosis of the Urinary Bladder

“…The characteristic distribution of deposits in the systemic form, heavily in vascular sites and relatively sparingly in muscle, as compared to that of the localised variety may be a clue as to the type of disease. Our Case 4 is one of the 4 proved examples (Bender and Kelly, 1969;Missen and Tribe, 1970) of systemic amyloidosis with symptomatic bladder involvement. Such findings are of great significance not only from the therapeutic standpoint but also from that of prognosis.…”

“…Incidence.-Vesical amyloidosis is rare, 38 cases have been reported so far (Houtappel and Lauwers, 1960;Kinzel et al, 1961;Werner, 1961;Nagel, 1961Nagel, , 1962Grace and Walton, 1964;Krzeski, 1964;Hudson and Tingley, 1965;Narwani and Lingard, 1966;Sinkevichus and Liutkus, 1966;Lerut and Lerut, 1967;Bender and Kelly, 1969;Tripathi and Desautels, 1969;Missen and Tribe, 1970). These, together with our 4 new cases, make a total of 42 cases.…”

“…Group 3. Patients with the typically diffuse lesion of systemic amyloidosis, usually presenting with severe hzmaturia, have a guarded prognosis much dependent on the involvement of other vital organs such as those of the renal, cardiovascular, and gastrointestinal systems (Missen and Tribe, 1970;our Case 4). Careful evaluation of these and other systems and maintenance of their normal function as well as transurethral management of bladder lesions, as warranted, is probably the logical approach.…”

New case of secondary bladder amyloidosis with massive hematuria—role of intravesical instillations with dimethyl sulfoxide

“…Once the disease is confirmed, there is a wide range of therapeutic alternatives depending on the severity of the case: from observation and conservative management with continuous bladder irrigation with saline in mild cases, to more aggressive measures ranging from transurethral resections (TUR) with resection/cauterization of the affected areas, to embolization of the hypogastric arteries or, in severe cases, even to a partial or total cystectomy (8,17).…”