罕見併發症:經尿道攝護腺雷射剜除手術後膀胱旁血腫

簡黃鎰、姜宜妮

國立台灣大學醫學院附設醫院泌尿部

Beyond the Norm: Unusual Perivesical Hematoma Post Laser TUEP

Huang-Yi Chien、I-Ni Chiang

Department of Urology, National Taiwan University Hospital, Taipei, Taiwan

Background: While TURP has been the gold standard for benign prostatic hyperplasia, laser enucleation procedures have risen as a size-independent alternative, with common complications including hematuria and clot retention. The use of suprapubic cystostomy during these surgeries varies based on surgeon preference and patient factors. We present a rare case of perivesical hematoma following laser TUEP with suprapubic cystostomy.

Case: An 84-year-old man with coronary artery disease on aspirin therapy presented with dysuria and sudden urinary retention. Two weeks earlier, he had undergone laser TUEP at another hospital without reported perioperative complications. He denied post-surgery hematuria or voiding issues. Sonography revealed an encapsulated supravesical fluid accumulation about 200 ml. Flexible cystoscopy showed no evidence of blood clots, residual prostate chips, or bladder rupture. Although morcellator injury during TUEP was initially suspected, no obvious wound scars were observed during cystoscopy. Subsequent CT scan suggested a potential extraperitoneal urinary bladder rupture with a sizable supravesical hematoma measuring about 14 cm. The patient disclosed that a suprapubic cystostomy had been inserted during laser TUEP and removed upon completion of the procedure. Further examination revealed a suprapubic scar consistent with the site of bladder rupture seen on the CT scan. A suprapubic pigtail catheter was then placed for drainage, yielding dark-red fluid. The catheter was removed after two weeks of placement. A follow-up CT scan three months later revealed a normal bladder without perivesical fluid accumulation.

Discussion/Conclusion: Regarding the use of suprapubic cystostomy alongside TURP or TUEP, it is often recommended to enhance the safety and efficacy of these procedures, mitigating challenges such as fluid absorption due to increased intraoperative intravesical pressure and potential visual obstructions from bleeding and debris. In our case, we encountered a patient with hypertension who was taking aspirin and experienced the unusual complication of a supravesical hematoma post-surgery. This highlights the need for a cautious approach and prompts consideration of delaying cystostomy removal in patients with a propensity for bleeding.