Takagi Kimiaki, Kojima Keitarou, Yuhara Kazuya, Shibata Yuhei
The Department of Urology, Takayama Red Cross Hospital, Takayama, Japan.
Hinyokika Kiyo. 2012 Dec;58(12):687-90.
An 80-year-old man presented to our hospital with macroscopic hematuria. Before coming to our hospital, he was treated for multiple myeloma with cyclophosphamide. We detected diffuse dilation of capillary on urinary bladder mucosa on cystoscopy, and diagnosed the patient with cyclophosphamide-induced hemorrhagic cystitis. Macroscopic hematuria once resolved by indwelling urethral catheter, but recurred and bladder tamponade developed. We performed transurethral electric coagulation. Macroscopic hematuria temporarily disappeared, but again relapsed. Then we performed intravesical instillation of aluminum hydroxide gel, but without a clear effect and the patient developed hemorrhagic shock. Eventually, we performed bilateral ureterostomy because the disease was unresponsive to less invasive therapies. Vesical bleeding disappeared and the patient was discharged 32 days after surgery. The treatment for multiple myeloma has been continued without cyclophosphamide since surgery.
一名80岁男性因肉眼血尿前来我院就诊。在来我院之前，他曾接受环磷酰胺治疗多发性骨髓瘤。膀胱镜检查发现膀胱黏膜毛细血管弥漫性扩张，诊断为环磷酰胺所致出血性膀胱炎。肉眼血尿曾通过留置尿道导管得以缓解，但复发后出现膀胱填塞。我们进行了经尿道电凝术。肉眼血尿暂时消失，但再次复发。随后我们进行了膀胱内灌注氢氧化铝凝胶，但效果不明显，患者出现失血性休克。最终，由于病情对侵入性较小的治疗无反应，我们进行了双侧输尿管造口术。膀胱出血消失，患者术后32天出院。自手术以来，多发性骨髓瘤的治疗一直在继续，但未使用环磷酰胺。
