Friday, May 21, 2010
Angioembolisation in Haemorrhagic cystitis
a 65 year old man presented to us with frank hematuria of 1 day duration. he was known case of small capacity bladder with hemorrhagic cystitis with no apparent reason.He was operated in 2002 for clam cystoplasty. He was apparently alright for 8 years just to land up in emergency department with gross total hematuria.
He is known case coronary artery disease and hypertension on medication.He was on ecosprin when he came for hematuria.
Immediately ecosprin was stopped.He was supported with irrigation,tranexa and cystoscopy and evacuation followed by alum irrigation.
After this surgery he was fine for 2 days then suddenly he had bout of frank hemturia causing fall of Hb from 13 TO 10 GM% and BP to fall from 130/80 mm Hg to 70/30 mmHg.
He was immediate taken up for cystoscopy and clot evacuation again with institution of proper blood support and plasma expander support.The bladder base region had angry looking globular mass? Rest of the bladder mucosa and the intestinal mucosa was normal.
The clots were removed with resectoscope and cautery and ellicke evacuator.A three way Foleys catheter was introduced wnd alum irrigation was started..The urine effluent was clear.
aFTER THE CLOT EVACUATION WAS DONE BILATERAL ANGIOEMBOLISATION WAS CARRIED OUT SELECTIVELY ON ANTERIOR DIVISION OF INTERNAL ILIAC ARTER USING SELDINGERS TECHNIQUE.The both iliac arteries anterior divison was blocked with gel foam mixture viscous with the contrast,
The process of Angioembolisation of the internal iliac artery --the end result of the embolisation is seen as the disapperance of the terminal branches of the vesical arteries.
The next plan was if the patient bleeds again then re-ileal conduit and extirpation of the diseased bladder at a later point of time.
The urological hemorrhage is an important problem in contemporary urological practice with significant associated morbidity and mortality. furthermore, these emergencies present a number of challenges to clinicians as current practice has evolved due to the increased availability of new imaging techniques and transarterial embolisation (tae). in this review we have explored the epidemiology, etiology and management of both renal and bladder hemorrhage. renal bleeding secondary to accidental or iatrogenic trauma and neoplastic disease requires careful but expeditious assessment and treatment. we have described current conservative, surgical and radiological approaches to the management of this challenging problem. moreover, bladder hemorrhage due to hemorrhagic cystitis, boadder cancer and infection represents a significant problem in current practice. advances in technology have changed the management options and again we have explored the literature in order to determine the optimum treatment approaches.