102
BRITISH JOURNAL OF UROLOGY
Spontaneous Rupture of the Bladder in Interstit ia I Cystitis A. J. HAMER, S. NICHOLSON and C. J. H. PADFIELD, Department of Surgery, Royal Infirmary; Department of Pathology, Maternity Hospital, Bristol
Rupture of the normal bladder is rare, especially in the absence of trauma (Evans e t a / . , 1976), but does occur with bladder disease or long-term catheterisation (Spees et al., 1981). Rupture of the bladder has been reported following hydrostatic distension in interstitial cystitis (Higson et al., 1978). Spontaneous bladder rupture, however, has not been previously reported in patients with interstitial cystitis. Case Report A 65-year-old lady presented with sudden, constant abdominal pain. She had not passed urine on the day prior to admission. She had not been recently catheterised. She had previously been investigated for symptoms of repeated urinary tract infections with cystoscopy, which demonstrated a small capacity bladder (100 ml). Biopsies showed non-specific features. Her most recent cystoscopy was over 2 months prior to admission. On examination she was dehydrated and febrile, with a rigid abdomen. A small volume of thick, purulent, sterile urine was obtained after bladder catheterisation. At laparotomy the intestine was intact, but a necrotic area was seen at the dome of the bladder with an obvious perforation. The remaining abdominal contents were entirely normal and the bladder perforation was oversewn successfully. She later underwent augmentation cystoplasty. Histology thus obtained showed partial ulceration of benign transitional epithelium with deep fissuring into detrusor muscle and associated hyperplasia of nerves. The detrusor muscle contained numerous mast cells. The appearances were consistent with a diagnosis of interstitial cystitis (Fig.).
Comment
To our knowledge, this is the first reported case of spontaneous bladder perforation associated with interstitial cystitis. The perforation occurred at the apex of one of the fissures in an acute manner. The apex of the fissure was the thinnest part of the bladder wall ;the surrounding tissue was relatively ischaemic because of fibrosis and would therefore be most susceptible to perforation if intravesical pressure rose.
Fig. Detrusor muscle stained with toluidine blue showing mast cells. ( x 125).
References Evans, R. A., Reece, R. W. and Smith, M. J. V. (1976). Idiopathic rupture of the bladder. J . Urol., 116,565-567. Higson, H., Smith, J. C. and Whelen, P. (1978). Bladder rupture: an acceptable complication ofdistension therapy? Br. J . Urol., 50,529-534. Spees, E. K., O’Mara,C., Murphy,J. B. e t d . (1981). Unsuspected intraperitoneal perforation of the urinary bladder as an iatrogenic disorder. Surgery, 89,224-23 I . Requests for reprints to: A. J. Hamer, Department of Surgery, Bristol Royal Infirmary, Marlborough Street, Bristol BS2 8HW.
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Rate of Development of Ureteric Obstruction in Idiopathic Retroperitoneal Fibrosis (Peri-aortitis) L. R. I. BAKER, R. CROXSON, N.KHADER, R. H. REZNEK, M. AL RUKHAlMl and J. E. A. WICKHAM, Departments of Nephrology and Radiology, St BartholomewS Hospital. London; Department of Medicine, Armed Forces Hospital, Daharan, Saudi Arabia
Before the advent of computed tomography (CT), most patients with idiopathic retroperitoneal fibrosis (peri-aortitis) presented to nephrologists or urologists with unilateral or, more commonly,
BRITISH JOURNAL OF UROLOGY
Spontaneous Rupture of the Bladder in Interstit ia I Cystitis A. J. HAMER, S. NICHOLSON and C. J. H. PADFIELD, Department of Surgery, Royal Infirmary; Department of Pathology, Maternity Hospital, Bristol
Rupture of the normal bladder is rare, especially in the absence of trauma (Evans e t a / . , 1976), but does occur with bladder disease or long-term catheterisation (Spees et al., 1981). Rupture of the bladder has been reported following hydrostatic distension in interstitial cystitis (Higson et al., 1978). Spontaneous bladder rupture, however, has not been previously reported in patients with interstitial cystitis. Case Report A 65-year-old lady presented with sudden, constant abdominal pain. She had not passed urine on the day prior to admission. She had not been recently catheterised. She had previously been investigated for symptoms of repeated urinary tract infections with cystoscopy, which demonstrated a small capacity bladder (100 ml). Biopsies showed non-specific features. Her most recent cystoscopy was over 2 months prior to admission. On examination she was dehydrated and febrile, with a rigid abdomen. A small volume of thick, purulent, sterile urine was obtained after bladder catheterisation. At laparotomy the intestine was intact, but a necrotic area was seen at the dome of the bladder with an obvious perforation. The remaining abdominal contents were entirely normal and the bladder perforation was oversewn successfully. She later underwent augmentation cystoplasty. Histology thus obtained showed partial ulceration of benign transitional epithelium with deep fissuring into detrusor muscle and associated hyperplasia of nerves. The detrusor muscle contained numerous mast cells. The appearances were consistent with a diagnosis of interstitial cystitis (Fig.).
Comment
To our knowledge, this is the first reported case of spontaneous bladder perforation associated with interstitial cystitis. The perforation occurred at the apex of one of the fissures in an acute manner. The apex of the fissure was the thinnest part of the bladder wall ;the surrounding tissue was relatively ischaemic because of fibrosis and would therefore be most susceptible to perforation if intravesical pressure rose.
Fig. Detrusor muscle stained with toluidine blue showing mast cells. ( x 125).
References Evans, R. A., Reece, R. W. and Smith, M. J. V. (1976). Idiopathic rupture of the bladder. J . Urol., 116,565-567. Higson, H., Smith, J. C. and Whelen, P. (1978). Bladder rupture: an acceptable complication ofdistension therapy? Br. J . Urol., 50,529-534. Spees, E. K., O’Mara,C., Murphy,J. B. e t d . (1981). Unsuspected intraperitoneal perforation of the urinary bladder as an iatrogenic disorder. Surgery, 89,224-23 I . Requests for reprints to: A. J. Hamer, Department of Surgery, Bristol Royal Infirmary, Marlborough Street, Bristol BS2 8HW.
~~
Rate of Development of Ureteric Obstruction in Idiopathic Retroperitoneal Fibrosis (Peri-aortitis) L. R. I. BAKER, R. CROXSON, N.KHADER, R. H. REZNEK, M. AL RUKHAlMl and J. E. A. WICKHAM, Departments of Nephrology and Radiology, St BartholomewS Hospital. London; Department of Medicine, Armed Forces Hospital, Daharan, Saudi Arabia
Before the advent of computed tomography (CT), most patients with idiopathic retroperitoneal fibrosis (peri-aortitis) presented to nephrologists or urologists with unilateral or, more commonly,
