Hematuria grave recidivante por amiloidosis vesical secundaria. Mikulicz transuretral como opción hemostática / Secondary bladder amyloidosis with severe recurrent hematuria: transurethral Mickuliz procedure as hemostatic option

RESUMEN

OBJETIVO: Al contrario que la amiloidosisvesical primaria o localizada, cuyo curso es generalmentebenigno, en la forma secundaria, consecuenciade amiloidosis sistémica, el sangrado puede sermasivo, con necesidad de procedimientos hemostáticosdesesperados como la ligadura de las arterias hipogástricaso la cistectomía. Describimos un caso en elque la hemostasia se logró mediante un taponamientovesical transuretral de tipo Mikulicz.MÉTODO Y RESULTADO: Una mujer de 58 años conartritis reumatoide muy agresiva, amiloidosis renalsecundaria y en hemodiálisis crónica, presentabahematuria grave después de haber sido operada de lacadera . Se le encontró una vejiga inflamatoria en cuyabiopsia, todas las capas estaban edematizadas y lasparedes de los vasos engrosadas por depósitos deamiloide. Después de varios procedimientos hemostáticostransuretrales infructuosos, se realizó una formolización vesical, y un taponamiento endovesical de tipoMikulicz con vendas de gasa introducidas a través dela uretra previamente dilatada. La gasa exteriorizadapor uretra pudo retirarse al tercer dia, sin que reaparecierala hematuria, aunque tuvo un posterior deterioroneurológico, falleciendo finalmente a los catorcedías de la última intervención.CONCLUSIÓN: El taponamiento vesical transuretral enuna mujer con hematuria intensa es una opción hemostáticaque recomendamos probar antes de elegir otrasmás dramáticas o invasivas

ABSTRACT

OBJECTIVES: Primary localized amyloidosis ;;of the urinary bladder generally has a benign course. ;;On the contrary, secondary amyloidosis, a consequence ;;of systemic amyloidosis, may have massive bleeding ;;and produce complications such as bladder rupture or ;;life-threatening hemodynamic problems requiring desperate ;;hemostatic procedures such as hypogastric artery ;;embolization or ligature, or cystectomy. We report one ;;case in which hemostasis was achieved by a Mickulicz ;;transurethral bladder tamponage. ;;METHODS: 58 year old female with very aggressive ;;rheumatoid arthritis and secondary renal amyloidosis ;;under chronic hemodialysis presenting with severe ;;hematuria after hip replacement. An inflamed bladder ;;was found, the biopsy of which showed edema in all ;;layers with blood vessel walls enlarged by amiloyd ;;deposits. After several unsuccessful transurethral hemostatic ;;procedures, intravesical formalin irrigation was carried ;;out together with a Mikulicz type gauze packaging after ;;urethral dilation. The gauze was withdrawn three days ;;later without bleeding recurrence; however she presented ;;subsequent neurological impairment and finally died 14 ;;days after the last urological procedure. ;;CONCLUSIONS: Transurethral packaging of the urinary ;;bladder in a woman with massive hematuria is a ;;hemostatic option that we recommend to be used before ;;other more dramatic or invasive options are chosenOBJECTIVES: Primary localized amyloidosis ;;of the urinary bladder generally has a benign course. ;;On the contrary, secondary amyloidosis, a consequence ;;of systemic amyloidosis, may have massive bleeding ;;and produce complications such as bladder rupture or ;;life-threatening hemodynamic problems requiring desperate ;;hemostatic procedures such as hypogastric artery ;;embolization or ligature, or cystectomy. We report one ;;case in which hemostasis was achieved by a Mickulicz ;;transurethral bladder tamponage. ;;METHODS: 58 year old female with very aggressive ;;rheumatoid arthritis and secondary renal amyloidosis ;;under chronic hemodialysis presenting with severe ;;hematuria after hip replacement. An inflamed bladder ;;was found, the biopsy of which showed edema in all ;;layers with blood vessel walls enlarged by amiloyd ;;deposits. After several unsuccessful transurethral hemostatic ;;procedures, intravesical formalin irrigation was carried ;;out together with a Mikulicz type gauze packaging after ;;urethral dilation. The gauze was withdrawn three days ;;later without bleeding recurrence; however she presented ;;subsequent neurological impairment and finally died 14 ;;days after the last urological procedure. ;;CONCLUSIONS: Transurethral packaging of the urinary ;;bladder in a woman with massive hematuria is a ;;hemostatic option that we recommend to be used before ;;other more dramatic or invasive options are chosen