Extensive Necrosis of the Bladder with Hypostatic Abscess: A Late Complication after Radiotherapy

Pandey, Abhishek; Beier, Joern; Dobkowicz, L.; Wolf, Simone; Keller, H.

doi:10.1159/000277763

Cited by 5 publications

(5 citation statements)

References 5 publications

(4 reference statements)

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“…Severe complications are extremely rare and can have a notoriously long latency period, for example bladder rupture and fistula formation. [ 14 ] Pandey et al [ 15 ] reported a case of extensive bladder necrosis with hydronephrosis and sepsis nearly 45 years after radiotherapy. Fortunately, after treatment, the patient recovered 6 months later with completely healed wounds and nearly normal renal parameters.…”

Section: Discussionmentioning

confidence: 99%

Urological complications after radical hysterectomy with postoperative radiotherapy and radiotherapy alone for cervical cancer

Guo²,

Qiu³

et al. 2018

Medicine

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Radiotherapy is a reliable method to cure cervical cancer patients, but it could cause serious urological complications after the treatment due to the anatomical location of the cervix. The main purpose of this retrospective analysis is to study the incidence, latency, and therapeutic efficacy of urological complications caused by radical hysterectomy with postoperative radiotherapy or radiotherapy alone in patients with cervical cancer.A retrospective analysis was conducted on patients with cervical cancer who received radical hysterectomy with postoperative radiotherapy or radiotherapy alone at the First Hospital of Jilin University between January 2010 and May 2016. The urological complications were confirmed by clinical manifestation, ultrasound, computed tomography (CT), nuclear scintigraphy, and assessment of renal function. All the patients with urological complications received conventional treatment, including conservative, electrosurgery, ureteral stents, nephrectomy, and neoplasty. The onset time of radiation injury symptoms was confirmed according to the medical history and follow-up. The surveillance for the therapeutic effects for these complications was accomplished by cystoscopy, imaging, and laboratory assessment.The overall rate of urological complications after treatment was 3.26%, comprising 2.12% ureteral obstruction, 0.98% radiocystitis, and 0.16% vesicovaginal fistula. The incidence of ureteral obstruction in patients treated with radical hysterectomy with postoperative radiotherapy and radiotherapy alone was not statistically significant (2.18% vs 1.59%, P > .05). The median onset time of radiocystitis and ureteral obstruction was 10 months (0–75 months) and 12 months (2–66.3 months), respectively. The onset time of vesicovaginal fistula was 3.5 months. After the appropriate treatment, the majority of the complications were under control.The incidence of urological complications is acceptable. There was no statistical difference in the risk between patients treated with radical hysterectomy with postoperative radiotherapy and radiotherapy alone. The latency period between radiotherapy and the manifestation of urological complications may be relatively long. So it is crucial to underline long-term follow-up after radiotherapy. The majority of urological complications were alleviated after symptomatic treatment and the patients with cervical cancer achieved long-term remissions or cures.

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Section: Discussionmentioning

confidence: 99%

Urological complications after radical hysterectomy with postoperative radiotherapy and radiotherapy alone for cervical cancer

Guo²,

Qiu³

et al. 2018

Medicine

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“…[9] Bladder necrosis has also been reported following hydrodistention, radiation exposure, infection, carcinoma, or iatrogenic damage to the bladder vascular supply. [10111213]…”

Section: Discussionmentioning

confidence: 99%

Bladder necrosis secondary to internal iliac artery embolization following pelvic fracture

Ali¹,

Nabi

Swami

et al. 2014

Urol Ann

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A 49-year-old man following a road traffic accident (RTA) had an unstable pelvic fracture with urethral injury. Internal pelvic fixation with Supra-pubic catheter (SPC) drainage of his bladder was done. This failed to stop the bleeding and a pelvic angiography with bilateral internal iliac embolization using steel coils was performed successfully controlling the bleeding. After 4 weeks, the patient developed wound infection (Clavien Grade III) and on exploration, bladder necrosis was found. A urinary diversion using ileal conduit with excision of bladder was performed. A biopsy of the excised bladder confirmed bladder necrosis with a foreign material (coil) in one arterial lumen.

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“…To achieve this, there must be partial necrosis of the bladder mucosa, sparing the detrusor, to allow regeneration of the mucosa. otherwise, bladder reconstruction is the only alternative, which was not feasible for our patient given the septic conditions and fragility of the bladder wall post radiation [15]. Hyperbaric oxygen has also been used as an adjunct to surgery and antibiotics helping to heal and regenerate tissues after debridement, improve vascularization and reduce bacterial colonization [8] [15].…”

Section: Discussionmentioning

confidence: 99%

Abdominal Wall and limb necrotizing fasciitis: an extremely rare post -operative complication

Sakhri,

Krimi,

Khessairi

et al. 2024

Preprint

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Introduction: Infectious affections are the most frequent post-operative complications, the rates have been reducing due to the administration of perioperative antibiotics and they are rarely serious. They are usually associated to pelvic collections, fistulas, urinary tract stenosis and, exceptionally, necrotizing fasciitis (FN) and pelvic organ necrosis [1].There is no well-codified therapeutic consensus,. An urgent care of pelvic necrosis requires surgical debridement of necrotic tissues with a broad-spectrum antibiotic. Case presentation: A 42-year-old female patient, was referred to our department for a stage IIIC2 adenocarcinoma of the uterine cervix. She underwent chemo-radiation followed by a colpo-hysterectomy . Two months after surgery, the patient presented with recto-vaginal fistula associated with a pelvic collection. Abdominal CT scan revealed a recto-vaginal fistula fed by a 5cm pelvic collection originating from the uterine cavity. The patient was treated with antibiotics and then underwent a surgical evacuation of the collection and a bypass colostomy. The post-operative period was marked by the occurrence of an extensive necrosis to pelvic organs, namely the bladder and the anterior wall of the rectum which extended to the anterior and medial left leg’s thigh compartments muscles. She also presented a thrombosis of the left external iliac vein and artery, with necrosis of their vascular walls. Given the septic conditions, a revascularization procedure was not feasible. A bilateral ureterostomy was required, as well as ligature of the left external iliac vessels. The patient underwent post-surgical palliative treatment, and she died one month after surgery of multivisceral failure due to sepsis. Conclusion: Necrotizing fasciitis is a rare, but extremely serious condition, with a mortality rate of up to 30%. The prognosis can be improved with rapid management and appropriate medical and surgical treatment including large excisions of necrotic tissue, and antibiotic therapy adapted to the suspected germs, essentially anaerobic ones.

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Extensive Necrosis of the Bladder with Hypostatic Abscess: A Late Complication after Radiotherapy

Cited by 5 publications

References 5 publications

Urological complications after radical hysterectomy with postoperative radiotherapy and radiotherapy alone for cervical cancer

Urological complications after radical hysterectomy with postoperative radiotherapy and radiotherapy alone for cervical cancer

Bladder necrosis secondary to internal iliac artery embolization following pelvic fracture

Abdominal Wall and limb necrotizing fasciitis: an extremely rare post -operative complication

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