Post-enterocystoplasty massive bleeding because of Arteriovenous malformation from bowel arteries : A very Rare Case

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 abdominal exploration.The patient again bleede after 5 days; again the bleed was torrential causing drop in hematocrit.

The patient was taken up for CT Angiography which showed a big arteriovenous malformation on the dome of the bladder feeded by superior mesenteric arteries.

the mesenteric artery being very crucial one the angioembolisation of it was not taken into consideration thinking of the sequele of catastrophe of mistaken blockage of main trunks.


The exploratotry laparotomy was performed.The adhesiolysis was performed.The dome of the bladder was thickened with multiple serpigenious vessels .This part of the bladder was excised and bladder was closed with Suprapubic tube in situ.

The abdomen was closed in layers with drain in pelvis.The post-operative period was uneventful with no episode of hematuria till 3 weeks post-operatively.

Free camp update

First date of the Free Consultation camp for Male Infertility and Prostatic problems in general population was a great success with 78 patients visiting the Hospital and checked by the experts here.They got investigations at subsidised rates and medications for 15 days free of the cost.
Dr Ramesh Ramayya(CEO and Chairperson),Dr Vishwabhar Nath(Clinical Director),Dr Naveenchandra Acharya(Consultant Urologist),Dr Mahesh Sable(Medical Superitendent) supervised and managed the camp activities.

Press Conference by Dr Ramayyas Urology and Nephrology Hospital

Dr Ramayyas Hospital arranged a press conference to spread awareness about the forthcoming health camp about male infertility and prostate problems in people.

Dr Vishwanbhar Nath(Clinical Director of Dr Ramayyas Hospital) and Dr Naveenchandra Acharya(Urologist and Andrologist)briefed about the male infertility and prostate issues to the conference.

The camp will be held at the Dr Ramayyas Hospital premises on 26 and 27 Th June from 10-4 pm.

Mitomycin C for prevention of bladder tumor recurrence

A 30 year old lady presented with history of hematuria and dysuria. There was no history of comorbidities.

There was no history of prior surgical intervention .

On evaluation her USG showed left lateral wall space occupying lesion 3x2 cm and positive urine cytology for malignancy.

She was taken up for Trans-Urethal Bladder tumor resection with Continuous wave Holmium Laser.The Mitomycin C is a 334-kD alkylating agent that inhibits DNA synthesis. The drug is usually instilled weekly for 6 to 8 weeks at dose ranges from 20 to 60 mg.
One review found a 38% reduction in tumor recurrence with MMC.
Optimization of MMC delivery can result in halving of the recurrence rate in some studies. This can be achieved by eliminating residual urine volume, overnight fasting, using sodium bicarbonate to reduce drug degradation, and increasing concentration to 40 mg in 20 mL.

Check up camp for rnlarged prostate and male infertility

We have arranged camp at Dr Ramayyas Urology and Nephrology Institute and Pramila Hospitals under patronage of Dr Ramesh Ramayya CE and chairman and able guidance of Dr Vishwambhar Nath.It will be kept on two days 26 and 27 th June 2010 from 10 am to 4 pm at the premises of the hospital.The patient can undergo tests worth 2500/- just for 700/- and free medications worth 15 days given.

Following symptoms - poor urine flow,urgency,frequency,night time frequent urinations,burning micturition,blood in the urine,prostate cancer and male infertility.The ejaculation problems will also be assessed and accordingly managed.

Dr Vishwambhar Nath(Clinical Director of the Hospital), Dr Naveenchandra Acharya(Andrologist) and Dr Mahesh Sable(Medical Superitendent) will be rendering their valuable services during the camp.