BJU International 2001 87 (4), 414

A.R. Pontin¹, D. Taylor¹ and R.D. Barnes¹

¹ Groote Schuur Hospital, Cape Town, South Africa

Comment 

References 

Authors 

A 53-year-old man had an aortic thrombosis, presenting with backache and unable to walk. Angiography confirmed the thrombosis below the renal vessels. Despite percutaneous thrombectomy the patient required bilateral above-knee amputations. His abdominal X-ray at that time was normal. Three months later he complained of a poor urinary stream, dysuria and lower abdominal pain; he was then noted to have a capacious calcified bladder (Fig. 1a) and had a UTI, with acid urine. He continued to deteriorate, and a month later had intractable lower abdominal pain and a heavily calcified contracted bladder (Fig. 1b). Bladder biopsies (Fig. 2) confirmed bladder necrosis and calcification, with no evidence of any specific infection. He was managed with an ileal conduit diversion.

Case report 

References 

Authors 

This patient's dystrophic calcification was caused by ischaemia after his aortic thrombosis. There was no history of calcifying conditions such as schistosomiasis or tuberculosis, and his acid urine excluded a diagnosis of alkaline encrusting cystitis. This latter condition occurs in persistently alkaline urine, caused by urea-splitting organisms in a compromised bladder [1]. Braf and Koontz [2] and Sieber [3] reported a delayed presentation of bladder necrosis after ischaemia. In their patients, necrosis occurred 33 and 43 days after unilateral hypogastric artery embolization. The present patient's relentless course took 4 months to develop. After the aortic thrombosis, the rectum is vulnerable to ischaemia and the present patient's lack of rectal symptoms implies an effective marginal artery system.

Case report 

Comment 

Authors 

Case report 

Comment 

A.R. Pontin, MB, ChB, FRCS, FCS, Consultant Urologist.

D. Taylor, MB, ChB, MMed(Path), PhD, Consultant Urologist.

R.D. Barnes, MB, ChB, FCS, Consultant Urologist.