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

Spontaneous bladder rupture attributable to a radical hysterectomy-associated neurogenic bladder in patients with cervical cancer: A case report and literature review

INTRODUCTION AND IMPORTANCE

Spontaneous bladder rupture (SBR) is an extremely rare urological emergency. Herein we report a rare case of SBR in a postoperative cervical cancer patient, which was attributable to bladder distension due to a radical hysterectomy-associated neurogenic bladder.

CASE PRESENTATION

A 74-year-old nulliparous Japanese patient with cervical cancer (pT1b3N0M0) presented with acute abdominal pain nine days after a radical hysterectomy. The pretreatment workup included plain computed tomography (CT) revealed the presence of ascites in the absence of gastrointestinal perforation. The patient was initially diagnosed with generalized bacterial peritonitis and treated with antibiotics. Urine outflow was noted 5 days later from the vaginal stump. Subsequent contrast-enhanced CT demonstrated a bladder wall defect with presence of contrast medium in the abdominal cavity. The patient was diagnosed with SBR and was conservatively treated with antibiotics and prolonged catheterization (4 weeks); these measures showed no signs of therapeutic efficacy. The patient was subsequently treated surgically with an ileal conduit urinary diversion. The patient is currently free of disease.

CLINICAL DISCUSSION

A literature review revealed that a history of pelvic radiotherapy is the main predisposing factor for SBR in women with cervical cancer. Our case serves to alert physicians that SBR should be considered a differential diagnosis in postoperative cervical cancer patients without a history of pelvic radiotherapy who experience generalized peritonitis symptoms or present as an acute abdomen.

CONCLUSION

SBR can develop in cervical cancer patients without a history of radiotherapy. This differential diagnosis should be considered in patients with a radical hysterectomy-associated neurogenic bladder.

A Rare Case of Recurrent Generalized Peritonitis Caused by Spontaneous Urinary Bladder Rupture after Radiotherapy: A Case Report and Literature Review

Since generalized peritonitis is a fatal disease, accurate diagnosis and treatment are important. In this paper, we report a case of recurrent generalized peritonitis associated with spontaneous urinary bladder rupture (SBR). A 65 year old woman, who underwent radiotherapy 21 years prior, was diagnosed with generalized peritonitis. Although the cause of the generalized peritonitis could not be identified, the patient recovered with conservative treatment in short period. However, recurrent episodes of generalized peritonitis occurred four times. We diagnosed the patient with urinary ascites due to SBR, based on a history of radiotherapy and dysuria. No recurrence of generalized peritonitis had occurred after accurate diagnosis and treatment with long-term bladder catheter placement. Since SBR often occurs as a late complication after radiotherapy, it is difficult to diagnose SBR, which leads to delayed treatment. This case and literature review of similar cases suggest that the information of the following might be helpful in the diagnosis of SBR: (i) history of recurrent generalized peritonitis, (ii) pseudo-renal failure, (iii) history of radiotherapy, (iv) dysuria, and (v) increase or decrease of ascites in a short period. It is important to list SBR in the differential diagnosis by knowing the disease and understanding its clinical features. This case and literature review will serve as a reference for future practices.

Acute extraperitoneal spontaneous bladder rupture in cervical cancer patient undergoing chemoradiation: A case report and review of the literature

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Spontaneous bladder ruptures have only been reported intraperitoneally, and years after the cessation of therapy.

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Extraperitoneal bladder rupture can occur with radiation therapy in treatment of cervical cancer.

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Improved reporting of toxicity is needed to identify types of genitourinary toxicity seen with modern chemoradiation.

The standard of care for locally advanced cervical cancer is pelvic radiotherapy with sensitizing cisplatin, and intracavitary brachytherapy. This standard of care treatment paradigm has best survival outcomes, however is associated with genitourinary toxicities. Spontaneous bladder rupture (SBR) is a rare complication of chemoradiation that has only been reported in literature as an intraperitoneal rupture occurring years after the cessation of treatment. We herein present a novel case of extraperitoneal SBR in a 27-year-old female with FIGO Stage IIIC cervical cancer and no prior surgical history who was undergoing chemoradiation with sensitizing cisplatin. During her final planned brachytherapy treatment upon instilling the bladder under ultrasound guidance, an anterior midline extraperitoneal rupture was noted. She was managed conservatively for several weeks and during this time was ultimately able to complete her external beam therapy and last cycle of cisplatin. After approximately ten weeks of conservative management, imaging demonstrated complete resolution of the rupture. A review of the literature suggests this complication tends to occur as an intraperitoneal rupture years after the cessation of therapy. Late genitourinary complications and types of complications are rarely reported in clinical trials, so it is difficult to determine the true incidence of rare complications and identify patients that may be at risk.

Nontraumatic urinary bladder rupture presenting as renal pseudo-failure and ascites

A 24-year-old man, with past medical history significant only for nocturnal enuresis until the age of 12 years, presented to the emergency department with acute abdominal pain after an episode of difficulty with micturition in the middle of the night. On presentation, physical examination was suggestive of ascites and laboratories revealed an elevated serum creatinine of 1.88 mg/dL. He was subsequently found to have a ruptured bladder, without any inciting trauma, which required surgical repair. His only surgical history is an unknown, apparently urologic, surgery when he was 11-12 years old. The patient's unique presentation prompts discussion of bladder rupture and its manifestations, the role of clinical information in informing imaging protocol, and the importance of sagittal images in identifying pathology.