Gross hematuria: a complication of intrapelvic cement intrusion in total hip replacement

Greenspan, Adam; Norman, A.

doi:10.2214/ajr.130.2.327

Cited by 24 publications

(9 citation statements)

References 11 publications

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“…The authors theorized that the heat generated by the exothermic polymerization of the methylmethacrylate cement caused damage to the iatrogenically thinned medial wall leading to intrapelvic cement extension and bladder injury. The average delay in symptom manifestation was 9.75 days (range 7-14 days), with all cases demonstrating intrapelvic cement extension [7] . Similarly, a 2006 case report by Kaldenbach and Roth [6] describes a patient with bladder injury secondary to intrapelvic cement extension 11 years after THA.…”

Section: Discussionmentioning

confidence: 98%

“…Damage to the urogenital track, and the consequences thereof, generally have a delayed clinical presentation and do not present intraoperatively. A 1978 case series of 4 patients by Greenspan and Norman [7] studied gross hematuria in patients who sustained urogenital injury after THA. The authors theorized that the heat generated by the exothermic polymerization of the methylmethacrylate cement caused damage to the iatrogenically thinned medial wall leading to intrapelvic cement extension and bladder injury.…”

Section: Discussionmentioning

confidence: 99%

“…The few case reports and series that document bladder injuries secondary to THA primarily describe delayed presentations and theorize etiologies related to hardware migration, medial screw and wire placement [2] , [3] , [4] , intrapelvic cement extension, thermal necrosis [2] , [5] , [6] , [7] , [8] , or subsequent adhesions [9] . There are no prior case reports describing bladder perforation relating to erosion of the pelvic floor and cotyloid fossa occurring intraoperatively during primary THA ( Tables 1 and 2 ).…”

Section: Introductionmentioning

confidence: 99%

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Intraoperative bladder perforation during primary total hip arthroplasty

et al. 2018

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We present a unique case of bladder perforation occurring intraoperatively during primary total hip arthroplasty. It is suspected that the patient's aberrant bladder anatomy, with idiopathic erosion of the quadrilateral space, predisposed the patient to bladder injury. Several preoperative risk factors for bladder injury were identified in the literature. These factors include cemented acetabular components, previous history of hip arthroplasty, history of pelvic trauma or intrapelvic surgery, and poor bone quality. Management of bladder injury, should it occur, includes bladder decompression with a Foley catheter, antibiotic administration, hemodynamic monitoring, and urology consult with close follow-up. This case reinforces the importance of urologic preoperative evaluation for anatomic variations of the bladder. In such cases, intraoperative Foley catheters to prevent distension may reduce the risk of perforation.

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Section: Discussionmentioning

confidence: 98%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Intraoperative bladder perforation during primary total hip arthroplasty

et al. 2018

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“…Four cases of hematuria occurring 7–14 days postoperatively were attributed to necrosis of the bladder wall by the exothermic polymerization of the methacrylate cement [3]. A case of delayed hematuria secondary to cement intrusion into the bladder occurring at 1 year postoperatively was reported by Memon et al [4].…”

Section: Discussionmentioning

confidence: 99%

Pelvic Mass 21 Years after Total Hip Arthroplasty

Miller

Tarter

2013

Case Reports in Urology

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Background. Long-term urologic complications after total hip arthroplasty are rare, and reports in the urologic literature are scant. We present a recent case and review the relevant literature. Case. A 77-year-old man was referred to the urology clinic for a single episode of gross painless hematuria, abnormal urine cytology, and pelvic mass. He had a significant smoking history. Surgical history included right total hip arthroplasty 21 years prior. Results. Pelvic ultrasound revealed a large mass abutting the right bladder wall. Subsequent computed tomography indicated that the mass was extrinsic to the bladder. Results of computed tomography-guided biopsy of the mass were consistent with foreign body granuloma. Surveillance imaging confirmed no growth or progression, and intervention was deferred. Conclusion. Long-term complications of total hip arthroplasty may present with signs and symptoms of urologic disease. Reports in the urologic literature are rare.

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“…Other uncommon reasons include vesico-cutaneous fistula, 3,4,5 Thomas et al: Ultrasound Findings of Acute Idiopathic Scrotal Edema TheScientificWorldJOURNAL (2004) 4 (S1), 24-26 vesico-acetabular fistula, 5,6,7 trans-trochanteric vesico-cutaneous fistula 8 and fistula between the ureter and the acetabular space.9 Hematuria may also be due to either to the exothermic reaction involved in polymerization of the methylmethacrylate or the mass effect of the extruded intrapelvic cement or both. 10,11,12,13 Review of the literature disclosed no report of hematuria due to pressure of a dislocated prosthetic stem of a total hip replacement on the bladder. This mechanism must be considered when hematuria is detected in a patient with a medical history of total hip arthroplasty.…”

Section: Discussionmentioning

confidence: 99%

Hematuria Due to an Intrapelvically Intruding Total Hip Replacement

Bach

Steingruber²,

Nogler³

et al. 2004

The Scientific World JOURNAL

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A 92 year old male patient was referred to our service because of gross hematuria. He had a history of numerous episodes of hematuria in the last year. A cystoscopy was performed as first measure. The bladder neck, the trigone and the ureteral orifices were normal. Inspection of the mucosa revealed a localized bleeding area three centimeter in diameter within the posterior wall of the bladder. This area was bulged by an extravesical solid tumor of unknown etiology. Local pressure had caused central necrosis, but no fistula could be observed. Plain radiographs of the pelvis were performed revealing severe osteolytic destruction of the right acetabulum, a proximal fracture of the right superior pubic ramus and central transpelvic dislocation of the prosthetic stem of a total hip replacement with the femoral head supporting at the contralateral sacroiliac joint (Figure 1). A computed tomography was performed demonstrating extravesical compression due to the dislocated prosthetic stem (Figure 3). Medical records revealed that the patient underwent total hip arthroplasty 22 years ago. Failure of the implant was reported but revision surgery was not performed. Revision surgery including removal of the intrapelvic prosthesis was initiated to avoid bladder rupture. Extraction of the stem was performed successfully, the patient recovered well and no further events of hematuria were recorded.

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Gross hematuria: a complication of intrapelvic cement intrusion in total hip replacement

Cited by 24 publications

References 11 publications

Intraoperative bladder perforation during primary total hip arthroplasty

Intraoperative bladder perforation during primary total hip arthroplasty

Pelvic Mass 21 Years after Total Hip Arthroplasty

Hematuria Due to an Intrapelvically Intruding Total Hip Replacement

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