以下泌尿道症狀表現之潛在致命性動脈瘤

林昌民、張成業

台大醫院竹東分院 外科部 泌尿科

 Potentially fatal artery aneurysms presenting with lower urinary tract symptoms

Chang-Min Lin, Chen-Yeh Chang

Division of Urology, Department of Surgery, National Taiwan University Hospital, Chu-Tung Branch, Hsinchu, Taiwan

Purpose:

We report a case of multiple potentially fatal artery aneurysms presenting with lower urinary tract symptoms.

Case Report:

A 71-year-old male had past history of hypertension without medication and smoking for 50 years. He suffered from urinary frequency and nocturia for 3 months. Because of persistent lower urinary tract symptoms, he went to our outpatient department for help. He appeared well and did not felt abdominal discomfort. There was no tenderness or palpable mass on his abdomen on examination. A digital examination revealed an enlarged prostate with two fingers in breadth and normal consistency. The rest of his physical exam was unremarkable. The urinalysis was unremarkable and PSA was normal. Bladder sonography disclosed two large hypoechoic masses above the bladder and prostate volume was 30 g. The following computed tomography showed 2 large sausage-like artery aneurysms of right common iliac and internal iliac arteries. The largest size of the aneurysms was 6.1 cm. It was likely that the patient’s urinary symptoms were caused by local compression of bladder. Then he was transferred to the cardiovascular section and endovascular repair for the aneurysms was scheduled. 

Conclusions:

Lower urinary tract symptoms are common presentation in patient with benign prostatic hyperplasia. However, the other rare causes of lower urinary tract symptoms are difficult to detect by simple urinary test and digital rectal examination, even by transrectal ultrasound. Iliac artery aneurysms account for an estimated 2% of intra-abdominal aneurysmal disease. It had been reported that up to 40% present acutely with rupture. With a rupture rate of 38% and associated high mortality, early detection and intervention is essential. Bladder sonography is one of the important tool to find the potentially fatal lesions as this patient. Aneurysm should be always kept in mind when we treat the patients with lower urinary tract symptoms, especially that only with irritative symptoms.