Iemura Yusuke, Fukui Shinji, Matsumura Yoshiaki, Kagebayashi Yoriaki, Toyoshima Yuta, Inoue Takeshi, Samma Shoji
The Department of Urology, Nara Prefecture General Medical Center.
The Department of Urology, Nara Medical University.
Hinyokika Kiyo. 2018 Jan;64(1):25-28. doi: 10.14989/ActaUrolJap_64_1_25.
A 69-year-old man received transurethral resection (TUR) ofbladder tumor. The histopathological diagnosis was urothelial carcinoma, high grade, pT1＋pTis. The surgical specimens obtained by second TUR showed no residual malignancy histopathologically. Intravesical Bacillus Calmette-Guerin (BCG) instillation therapy was initiated 2 months after the second TUR. He complained of lower abdominal pain and painful urination on the day following the second instillation of BCG. Computed tomography and cystography demonstrated rupture ofthe urinary bladder. During 2 weeks ofconservative treatment, the symptoms persisted. Then, open repair ofthe bladder was performed. Intravesical BCG therapy has been a widely accepted treatment for bladder cancer with high grade Ta and T1, and carcinoma in situ. In the present case, thinning ofthe bladder wall, delayed wound healing caused by 2 TURs, and abdominal pressure may have been the factors leading to the bladder rupture in addition to inflammation of the bladder due to BCG instillation. Although bladder rupture caused by intravesical BCG therapy has not been reported, we must be aware ofthe possibility ofthis rare condition, especially after 2 consecutive TURs.
一名69岁男性接受了膀胱肿瘤经尿道切除术（TUR）。组织病理学诊断为高级别尿路上皮癌，pT1＋pTis。第二次TUR获取的手术标本在组织病理学上未显示残留恶性肿瘤。第二次TUR术后2个月开始膀胱内卡介苗（BCG）灌注治疗。在第二次灌注BCG后的次日，他主诉下腹部疼痛和排尿疼痛。计算机断层扫描和膀胱造影显示膀胱破裂。在2周的保守治疗期间，症状持续存在。随后，进行了膀胱开放修复术。膀胱内BCG治疗已成为广泛接受的治疗高级别Ta和T1期膀胱癌以及原位癌的方法。在本病例中，除了BCG灌注引起的膀胱炎症外，膀胱壁变薄、两次TUR导致的伤口愈合延迟以及腹压可能是导致膀胱破裂的因素。尽管尚未报道过膀胱内BCG治疗引起的膀胱破裂，但我们必须意识到这种罕见情况的可能性，尤其是在连续两次TUR之后。
