經尿道膀胱腫瘤切除手術後橫紋肌溶解症及急性腎衰竭
鄭人豪、陳正哲、歐宴泉
臺中榮民總醫院外科部泌尿外科
Rhabdomyolysis and acute renal failure following transurethral resection of bladder tumor
Jen-Hao Cheng, Cheng-Che Chen, Yen-Chuan Ou.
Divisions of Urology, Department of Surgery, Taichung Veterans General Hospital, Taichung, Taiwan
Abstract:
For treatment naive bladder tumor, transurethral resection (TUR) is the most common treatment. TUR is not only for diagnosis, but curative management for superficial bladder tumors. During the first time of operation, deep muscle biopsy is necessary for suspected high stage tumors. Bladder perforation may happen when resection of the base of tumor or deep muscle biopsy.
We report a patient with huge bladder tumor, 6cm in size, which was removed with monopolar resectoscope in lithotomy position. The procedure was complicated by right lateral bladder perforation and abdominal distention. The patient developed acute renal failure in two days. Compartment syndrome with rhabdomyolysis was diagnosed. On the other hand, post-operative hemorrhage may also play a potential role, in the appearance of ARF. Overall, our case shows that rhabdomyolysis and ARF can develop by retroperitoneal water dissection related compartment syndrome. Bladder perforation is the most important risk factor for such complications.