Gangrene of the Bladder A Rare Cause of Recurrent Catheter Blockages

Main Article Content

Mr William Britnell
Dr Rachel Hawthorne
Mr Paul Hadway

Keywords

Gangrenous cystitis, Cystoscopic debridement, catheter blockage

Abstract

 


Gangrene of the bladder is fortunatley now very rare, with better obstetric care and the advent of the antibioic era. It can present fulminatly with bladder rupture, or less commonly with the sequelae of necrotic urothlium and detrusor causing recurrent episiodes of sepsis, urinary retention or catheter blockages. A high level of morbidity and mortality is associated with the condition.


Case History


We present a case of a 75 year old male with multiple co-morbidities, including diabetes and vascular disease, who presented to the urology team with recurrent episodes of sepsis and frequent blockage of his long term urethral catheter. After months of no catheter problems, he was admitted to intensive care with severe sepsis following a catheter blockage at home. After discharge he suffered multiple further episodes of urinary sepsis and catheter blockages, requiring almost daily catheter changes. After multiple imaging investigations looking for a source of the recurrent severe infections, a cystoscopy under general anaesthtic revealed a large volume of necrotic tissue in his bladder, which, on biopsy, was found to be sloughed urothelium and detrusor muscle consistent with recent gangrene of the bladder. No problems with the ctaheter were reported after the bladder washout and cystoscopic debridement


Discussion


The diagnosis of bladder gangrene was delayed becuase of the patients insideous presentation. Had the imaging investigations revelaed an associated bladder rupture when he intially presented to ITU , it is likley that the diagnosis and appropriate debridement would have been perfomed sooner. The patient required muliple readmissions with a blocked catheter before the diagnosis was made, but the eventual cystoscopic debridement was successful.


Conclusion


Clinicians should keep gangrene of the bladder on the list of differential diagnoses for recurrent catheter blockages, particularly if recognised risk factors have been present. These include a history of catheterisation, vascular disease, diabetes, recent critical illness requiring inotropes and urinary tract infections.

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References

1. Stirling WC, Hopkins GA. Gangrene of the bladder. Review of two hundred and seven cases: report of two personal cases. J Urol 1934;31:517. Available at: https://www.auajournals.org/doi/pdf/10.1016/S0022-5347%2817%2972417-2

2. De Rosa A, Amer T, Waraich N, et al. Gangrenous cystitis in a 42-year-old male. Case Rep 2011;2011:bcr1120103526. Available at: https://casereports.bmj.com/content/2011/bcr.11.2010.3526.full#ref-1