Bosschieter Judith, Oudshoorn Frederik H K, Meuleman Eric J H, Nieuwenhuijzen Jakko A
Department of Urology, VU University Medical Center, Amsterdam, The Netherlands.
Urology, Spaarne Hospital, Hoofddorp, The Netherlands.
BMJ Case Rep. 2018 Feb 17;2018:bcr-2016-217769. doi: 10.1136/bcr-2016-217769.
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.
自抗生素应用以来，膀胱坏死已成为一种罕见病症。我们报告一例90岁男性在尿潴留后发生膀胱坏死的病例。经尿道插入导尿管（TUC）后，引出了2升尿液。在接下来的几天里，TUC间歇性堵塞。尽管进行了大量冲洗并放置了耻骨上导尿管，但仍无法实现膀胱的充分引流。手术探查发现，除膀胱三角区外，几乎整个膀胱壁均发生坏死。在未打开腹腔的情况下对无活力的膀胱壁进行了手术清创，并在Retzius腔置入TUC以确保尿液引流。由于患者血流动力学不稳定，放弃了尿流改道手术，接受通过TUC对Retzius腔进行尿液引流，从而在不影响肾功能的情况下实现了充分的尿液引流。
