Bladder rupture after voiding cystourethrography: A case report and literature review on pitfalls and bladder volume estimation

Abstract

Voiding cystourethrography (VCUG) is a common diagnostic study in pediatric urology. Although generally considered a safe procedure, VCUG can incur some complications. Bladder rupture following VCUG is a very rare complication and mostly happens in the setting of unused bladders, previous surgeries, or underlying disease. The rupture is almost always intraperitoneal needing prompt surgical treatment. We present a unique case of extraperitoneal bladder rupture after VCUG in an 8-month-old boy. The rupture remained unnoticed and the patient recovered spontaneously without medical or surgical intervention. To the best of our knowledge, this is the first such case report in the English literature. The information provided may guide clinicians on the proper use of bladder volume formulas in children and also help them in getting a proper VCUG study.

Do infants in the neonatal intensive care unit diagnosed with urinary tract infection need a routine voiding cystourethrogram?

“…7 While VCUG is considered a relatively safe study with patient and parent anxiety as the main complication, in addition to the cost and radiation exposure, rare complications have been reported, including bladder rupture in children and infants. 14,15…”

Extravasation of the Contrast Material During Voiding Cystourethrography in a Chronic Spinal Cord Injury Patient: A Case Report

“…Bladder rupture is divided into intraperitoneal and extraperitoneal bladder rupture. As intraperitoneal bladder rupture occurs because of rapidly rising intraperitoneal pressure, most cases of extravasation of contrast media following VCUG in children show intraperitoneal rupture [ 4 ] and require open or laparoscopic surgery. However, the management of extraperitoneal bladder rupture should be individualized, as in our case [ 6 ].…”

“…Till now, there have been several reports about extravasation of material during VCUG, but in most of the cases, extravasation of material occurred in pediatric patients [ 2 3 4 ]. This might be due to a thin bladder wall and excessive amount of volume infused into the bladder [ 5 ].…”

Pediatric voiding cystourethrography: An essential examination for urologists but a terrible experience for children

“…Urosepsis and death as a result of VCUG‐related UTI has been anecdotally reported . Several cases of iatrogenic bladder rupture after VCUG have also been reported when using indwelling Foley catheters and contrast medium instilled manually using a syringe …”

“…46 Several cases of iatrogenic bladder rupture after VCUG have also been reported when using indwelling Foley catheters and contrast medium instilled manually using a syringe. 47,48 Moves to reduce VCUG Because of the risk of renal scarring, VCUG or DMSA scanning is recommended after febrile UTI. Recently, indications for both are becoming more restricted due to significant radiation exposure, risk of catheter-induced UTI, distress for children and their parents, and cost.…”