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Trans-urethral prostate resection bladder injury

Case contributed by Noelani Silverio Gonzales
Diagnosis certain

Presentation

Abdominal pain, fever, and chills. Three days status post transurethral resection of the prostate.

Patient Data

Age: 60 years
Gender: Male

CT Abdomen Pelvis

ct

Status post trans-urethral resection of the prostate. The bladder is decompressed around a foley catheter. There is a focus of extraluminal air anterior to the bladder neck in an area of marked wall thinning as well as in the lateral right deep pelvis, with extensive extraperitoneal and space of Retzius fluid (blood and/or urine). Findings are highly suspicious for bladder leak which would be better characterized by dedicated cystourethrogram.

Peritoneal layering of free fluid and stranding anterior to the bladder suspicious for blood products or extravasated urine. No well organized fluid collection, however superinfection is difficult to exclude.

Voiding cystourethrography

Fluoroscopy

Irregular thick-walled bladder with extraperitoneal lower bladder leak.

Right lateral projecting contrast extraperitoneal contrast extravasation. 

Bilateral, spontaneous vesicoureteral reflux with moderate hydroureteronephrosis.

Indwelling foley catheter.

Case Discussion

This patient's imaging demonstrates extraperitoneal bladder injury secondary to trans-urethral resection of the prostate. His management included maintaining a foley catheter, administration of IV antibiotics, and consideration of bilateral stent placement with no improvement. 

This case was submitted with supervision and input from:
Ryan Hoffman, D.O. (Resident Radiologist) & Cameron Overfield, M.D. (Resident Radiologist) 
Mayo Clinic, Jacksonville
Department of Diagnostic and Interventional Radiology

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