PMID- 32513945
OWN - NLM
STAT- MEDLINE
DCOM- 20210827
LR  - 20210827
IS  - 2058-6124 (Electronic)
IS  - 2058-6124 (Linking)
VI  - 6
IP  - 1
DP  - 2020 Jun 8
TI  - Iatrogenic bladder rupture in individuals with disability related to spinal cord 
      injury and chronic indwelling urethral catheters.
PG  - 47
LID - 10.1038/s41394-020-0296-3 [doi]
LID - 47
AB  - INTRODUCTION: Bladder rupture in patients with indwelling urethral catheters is 
      rare. Herein, we describe two spinal cord injured (SCI) patients with neurogenic 
      bladder dysfunction managed with chronic indwelling catheters who presented with 
      extraperitoneal bladder rupture related to bladder instillation. One case was 
      during continuous bladder irrigation for hematuria, the other during routine 
      cystography. CASE PRESENTATION: One patient is a tetraplegic male with a C5 ASIA 
      impairment scale (AIS) SCI and a chronic catheter who presented with gross 
      hematuria and autonomic dysreflexia (AD). Continuous irrigation was complicated 
      by ongoing AD and poor catheter drainage. A CT scan revealed an extraperitoneal 
      bladder rupture which was managed with surgical repair and suprapubic catheter. 
      The second patient is a tetraplegic female who underwent gravity cystography to 
      evaluate for vesicoureteric reflux. She experienced AD, followed by a witnessed 
      extraperitoneal rupture. The rupture resolved with continued catheter drainage. 
      No long term complications were noted. DISCUSSION: We present two cases of 
      extraperitoneal rupture in chronically catheterized SCI patients following 
      bladder instillation. Both patients were undergoing instillation of fluid through 
      balloon catheters which likely occluded the outlet. We believe that rupture in 
      both cases was iatrogenic, from elevated intravesical pressures during gravity 
      instillation of fluid. Both patients experienced AD during these events. A 
      procedure involving bladder instillation in chronically catheterized SCI patients 
      should be performed by providers familiar with management of AD. Risk factors for 
      iatrogenic bladder rupture during instillation procedures likely include chronic 
      catheterization, small bladder capacity, instillation under significant pressure, 
      and occlusion of the bladder outlet by a balloon catheter.
FAU - Teplitsky, Seth L
AU  - Teplitsky SL
AUID- ORCID: 0000-0001-9242-1360
AD  - Department of Urology, Sidney Kimmel Medical College, Thomas Jefferson 
      University, Philadelphia, PA, USA.
FAU - Leong, Joon Yau
AU  - Leong JY
AUID- ORCID: 0000-0002-1698-8442
AD  - Department of Urology, Sidney Kimmel Medical College, Thomas Jefferson 
      University, Philadelphia, PA, USA.
FAU - Shenot, Patrick J
AU  - Shenot PJ
AD  - Department of Urology, Sidney Kimmel Medical College, Thomas Jefferson 
      University, Philadelphia, PA, USA. patrick.shenot@jefferson.edu.
LA  - eng
PT  - Case Reports
PT  - Journal Article
DEP - 20200608
PL  - England
TA  - Spinal Cord Ser Cases
JT  - Spinal cord series and cases
JID - 101680856
SB  - IM
MH  - Humans
MH  - Iatrogenic Disease
MH  - Male
MH  - Middle Aged
MH  - Postoperative Complications
MH  - Quadriplegia/*complications
MH  - Spinal Cord Injuries/*complications/*surgery
MH  - Urinary Bladder, Neurogenic/*surgery
MH  - Urinary Catheterization/*adverse effects
PMC - PMC7280260
COIS- PS receives financial support from Ipsen for investigation, and is a consultant 
      for Merck. The other authors have nothing to disclose.
EDAT- 2020/06/10 06:00
MHDA- 2021/08/28 06:00
PMCR- 2021/06/08
CRDT- 2020/06/10 06:00
PHST- 2020/04/23 00:00 [received]
PHST- 2020/05/13 00:00 [accepted]
PHST- 2020/05/12 00:00 [revised]
PHST- 2020/06/10 06:00 [entrez]
PHST- 2020/06/10 06:00 [pubmed]
PHST- 2021/08/28 06:00 [medline]
PHST- 2021/06/08 00:00 [pmc-release]
AID - 10.1038/s41394-020-0296-3 [pii]
AID - 296 [pii]
AID - 10.1038/s41394-020-0296-3 [doi]
PST - epublish
SO  - Spinal Cord Ser Cases. 2020 Jun 8;6(1):47. doi: 10.1038/s41394-020-0296-3.