Wei Zong-Jie, Zhu Xin, Yu Hai-Tao, Liang Zong-Jian, Gou Xin, Chen Yong
Department of Urology, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China.
World J Clin Cases. 2021 Jun 26;9(18):4810-4816. doi: 10.12998/wjcc.v9.i18.4810.
Hematuria is one of the most common clinical symptoms for urologists and is typically observed in urinary system tumors, prostate hyperplasia, and urinary stone disease. Hematuria due to vesical varices is very rare, and only a few cases have been reported since 1989. We report the first case of vesical varices due to portal hypertension with aberrant development and functioning of the genitourinary system along with the complete diagnosis and treatment process.
This patient was a 53-year-old man with a history of aberrant development of the genitourinary system and hepatitis B-associated cirrhosis. He was admitted to the emergency department with severe hematuria and bladder clot tamponade. Many abnormally dilated blood vessels were found surrounding the bladder in the pelvis by color Doppler ultrasound, contrast-enhanced computed tomography, and three-dimensional visualization technology. It was difficult to perform transurethral cystoscopy and hemostasis in this patient, so we performed open surgical bladder exploration for hemostasis and surgical devascularization around the bladder.
Urologists should improve the understanding of the pathophysiology, clinical manifestations, diagnosis, and treatment of vesical varices. This case may be presented as a reference for the diagnosis and management of severe hematuria due to vesical varices.
血尿是泌尿外科医生最常见的临床症状之一，常见于泌尿系统肿瘤、前列腺增生和尿路结石病。膀胱静脉曲张引起的血尿非常罕见，自1989年以来仅有少数病例报道。我们报告首例因门静脉高压导致膀胱静脉曲张并伴有泌尿生殖系统异常发育和功能异常的病例，以及完整的诊断和治疗过程。
该患者为一名53岁男性，有泌尿生殖系统异常发育和乙型肝炎相关性肝硬化病史。因严重血尿和膀胱血块填塞入住急诊科。通过彩色多普勒超声、增强计算机断层扫描和三维可视化技术，在盆腔内膀胱周围发现许多异常扩张的血管。该患者难以进行经尿道膀胱镜检查和止血，因此我们进行了开放性手术膀胱探查以止血并对膀胱周围进行手术去血管化。
泌尿外科医生应提高对膀胱静脉曲张的病理生理学、临床表现、诊断和治疗的认识。该病例可为膀胱静脉曲张所致严重血尿的诊断和管理提供参考。
