Bladder necrosis secondary to internal iliac artery embolization following pelvic fracture

A 49-year-old man following a road traffic accident [RTA] had an unstable pelvic fracture with urethral injury. Internal pelvic fixation with Supra-pubic catheter [SPC] drainage of his bladder was done. This failed to stop the bleeding and a pelvic angiography with bilateral internal iliac embolization using steel coils was performed successfully controlling the bleeding. After 4 weeks, the patient developed wound infection [Clavien Grade III] and on exploration, bladder necrosis was found. A urinary diversion using ileal conduit with excision of bladder was performed. A biopsy of the excised bladder confirmed bladder necrosis with a foreign material [coil] in one arterial lumen

Mitomycin C instillation following ureterorenoscopic laser ablation of upper urinary tract carcinoma

Instillation of Mitomycin C [MMC] should prevent implantation of cancer cells released during endoscopic treatment and prevent recurrences as seen in carcinoma of the bladder. To develop and evaluate a protocol for a single dose MMC instillation following Holmium: YAG laser ablation of upper urinary tract transitional cell carcinoma [UUT-TCC]. A single institute prospective study. MMC instillations protocol was designed and offered to patients between August 2005 and April 2011. Following tumor ablation, MMC was instilled into upper urinary tract [UUT] over 40 minutes. All the patients were regularly followed up. Twenty UUT units [19 patients] were managed for UUT-TCCs using our MMC protocol. Two UUT units had G1pTa tumors, 14 had G2pTa, 2 had G3pTa, and 2 had G3pT1. At a mean follow-up of 24 months [range 1-72 months], 13/20 [65%] of the UUT units remained cancer-free, 3 [15%] UUT units developed stricture and were treated with endoscopic dilatation, only 1 [5%] of these developed long-term complications. None of the patients developed postoperative renal impairment or systemic side-effects. Using a set standard protocol, MMC can safely be instilled into the UUT after TCC ablation with minimal complications or side effects, good preservation of renal function, and with a low recurrences rate comparable to the literature.