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Bladder rupture secondary to emphysematous bladder: A diabetic patient report
e106
Disclosure of interest peting interest.
Neuro-urology / Annals of Physical and Rehabilitation Medicine 59S (2016) e103–e106
The authors declare that they have no com-
http://dx.doi.org/10.1016/j.rehab.2016.07.233
PO0124
Bladder rupture secondary to emphysematous bladder: A diabetic patient report Astrid Balanc¸a AP–HP, médecine physique et réadaptation, Paris, France
Posters PO0123
Dystonia of the lower limb after sacral neuromodulation implanted to a 16-year-old boy with non-obstructive chronic urinary retention
∗ , Gilberte Robain , Samy Bendaya ¨ Teng Maelys Hopital Rothschild médecine physique et de réadaptation, Paris, France ∗ Corresponding author. ¨ E-mail address: [email protected] (T. Maelys)
Objective Sacral neuromodulation is usually used to treat nonobstructive urinary retention when other forms of treatment have failed. An improvement greater than 50% in urinary symptoms after 40 months of follow-up has been shown: – moreover, it also has few complications: infections, technical failures, discomfort; – we report a case of dystonia of the lower limb, appeared after sacral neuromodulation implantation. Observations MMP is a 16-year-old boy with early puberty as noteworthy medical history. It began in 2012, with dysuria and a loss of urinary feeling (not improved by antibiotics and anticholinergics), after a viral diarrhea episode with abdominal pain treated with morphine. In 2013, he had an acute painless urinary retention after a viral infection and had a bladder catheter for 3 weeks, then a neuromodulation of the 3rd sacral nerve was implanted with disappearance of the urinary symptoms. However, a few months later, a dystonia of the right lower limb appeared, with a shaking limb at knee flexion, a stiff-legged gait and claw toes. The cerebral and spine MRI, the lumbar puncture were normal. When the sacral neuromodulation was stopped, the dystonia declined, but he had several urinary retentions and used self-catheterizations with difficulties and pain. In our hospital (March 2016), neuromodulation was on, with no more effectiveness on the urinary symptoms, but the dystonia and claw toes were still there. When neuromodulation was stopped, claw toes disappeared. We also did a motor branch block of the rectus femoris and after 30 minutes, the knee flexion was nearly complete without any dystonia, and the gait was normal. Discussion/Conclusion This dystonia of the lower limb was probably due to the sacral neuromodulation because it appeared when it was on, and had intensity correlated to the intensity of the stimulation. However, it may have a psychological part to this process because such side effect has never been described before and the motor block was very quickly effective. Keywords Sacral neuromodulation; Dystonia; Side effect; Urinary retention/therapy Disclosure of interest The authors have not supplied their declaration of competing interest. http://dx.doi.org/10.1016/j.rehab.2016.07.234
Objective We report an emphysematous cystitis in a diabetic patient complicated by peritonitis. Observations A 66-year-old male presented to the emergency with septic shock. Patient’s history: poorly controlled diabetes and prostate adenoma. Clinical examination revealed a surgical abdomen and signs of shock. Blood sugar was 6 g/L. CRP 274 mg/L. The abdomino-pelvic CT scan showed a perforated bladder with emphysema of the bladder wall and endoluminal air bubbles. The patient was transferred to the intensive care unit. Empirical antibiotic therapy was administered. The surgery consisted of a double-DD with peritoneal lavage and bladder closure. Then, treatment adaptation with cefotaxime, flagyl for Klebsiella pneumoniae. Prior to prostatectomy, a urinary catheter was implemented a month in advance in order to relax the detrusor muscles. The patient was transferred to PMR unit for rehabilitation due to both mixed neuropathy (diabetic and resuscitation) and vesicosphincter disorders. Discussion/Conclusion In addition to emphysematous cystitis being rare, combining with cystitis and air in the bladder wall elevates the severeness. Clinical symptoms severeness is stagedependent. The presence of the pneumaturia should eliminate differential diagnosis of rectovesical fistula. The association of bladder rupture adds to the complication. It mainly affects older females [1]. The predisposing factors are diabetes and urinary stasis (neurogenic bladder, chronic urinary retention). The most common bacteria are Escherichia coli (58%) and K. pneumoniae (21%). The fermentation of glucose to formic acid during the breathing of bacteria forms carbon dioxide. [2] The CT scan is the first line of investigation, which shows aeric hypodensities and the extension of the lesions. [3] Treatment focuses on parenteral antibiotic therapy with surgical intervention. Despite the 20% mortality rate, outcomes were favorable in most cases. The underlying cause of emphysematous cystitis and its catastrophic consequences affecting the urinary tract necessitates both of urological follow-up and rehabilitation. Keywords Emphysematous cystitis; Perforated bladder; Diabete; Prostate adenoma Disclosure of interest The author has not supplied his/her declaration of competing interest. References [1] Emphysematous cystitis: a review of 135 cases. BJU Int 2007;100:17–20. [2] Gas forming infection of the urinary tract: an investigation of fermentation as a mechanism. J Urol 1990;143(5):960–4. [3] Cystite emphysemateuse aspect scannographique : à propos d’un cas. J Radiol 1993;74:439–40. http://dx.doi.org/10.1016/j.rehab.2016.07.235
Disclosure of interest peting interest.
Neuro-urology / Annals of Physical and Rehabilitation Medicine 59S (2016) e103–e106
The authors declare that they have no com-
http://dx.doi.org/10.1016/j.rehab.2016.07.233
PO0124
Bladder rupture secondary to emphysematous bladder: A diabetic patient report Astrid Balanc¸a AP–HP, médecine physique et réadaptation, Paris, France
Posters PO0123
Dystonia of the lower limb after sacral neuromodulation implanted to a 16-year-old boy with non-obstructive chronic urinary retention
∗ , Gilberte Robain , Samy Bendaya ¨ Teng Maelys Hopital Rothschild médecine physique et de réadaptation, Paris, France ∗ Corresponding author. ¨ E-mail address: [email protected] (T. Maelys)
Objective Sacral neuromodulation is usually used to treat nonobstructive urinary retention when other forms of treatment have failed. An improvement greater than 50% in urinary symptoms after 40 months of follow-up has been shown: – moreover, it also has few complications: infections, technical failures, discomfort; – we report a case of dystonia of the lower limb, appeared after sacral neuromodulation implantation. Observations MMP is a 16-year-old boy with early puberty as noteworthy medical history. It began in 2012, with dysuria and a loss of urinary feeling (not improved by antibiotics and anticholinergics), after a viral diarrhea episode with abdominal pain treated with morphine. In 2013, he had an acute painless urinary retention after a viral infection and had a bladder catheter for 3 weeks, then a neuromodulation of the 3rd sacral nerve was implanted with disappearance of the urinary symptoms. However, a few months later, a dystonia of the right lower limb appeared, with a shaking limb at knee flexion, a stiff-legged gait and claw toes. The cerebral and spine MRI, the lumbar puncture were normal. When the sacral neuromodulation was stopped, the dystonia declined, but he had several urinary retentions and used self-catheterizations with difficulties and pain. In our hospital (March 2016), neuromodulation was on, with no more effectiveness on the urinary symptoms, but the dystonia and claw toes were still there. When neuromodulation was stopped, claw toes disappeared. We also did a motor branch block of the rectus femoris and after 30 minutes, the knee flexion was nearly complete without any dystonia, and the gait was normal. Discussion/Conclusion This dystonia of the lower limb was probably due to the sacral neuromodulation because it appeared when it was on, and had intensity correlated to the intensity of the stimulation. However, it may have a psychological part to this process because such side effect has never been described before and the motor block was very quickly effective. Keywords Sacral neuromodulation; Dystonia; Side effect; Urinary retention/therapy Disclosure of interest The authors have not supplied their declaration of competing interest. http://dx.doi.org/10.1016/j.rehab.2016.07.234
Objective We report an emphysematous cystitis in a diabetic patient complicated by peritonitis. Observations A 66-year-old male presented to the emergency with septic shock. Patient’s history: poorly controlled diabetes and prostate adenoma. Clinical examination revealed a surgical abdomen and signs of shock. Blood sugar was 6 g/L. CRP 274 mg/L. The abdomino-pelvic CT scan showed a perforated bladder with emphysema of the bladder wall and endoluminal air bubbles. The patient was transferred to the intensive care unit. Empirical antibiotic therapy was administered. The surgery consisted of a double-DD with peritoneal lavage and bladder closure. Then, treatment adaptation with cefotaxime, flagyl for Klebsiella pneumoniae. Prior to prostatectomy, a urinary catheter was implemented a month in advance in order to relax the detrusor muscles. The patient was transferred to PMR unit for rehabilitation due to both mixed neuropathy (diabetic and resuscitation) and vesicosphincter disorders. Discussion/Conclusion In addition to emphysematous cystitis being rare, combining with cystitis and air in the bladder wall elevates the severeness. Clinical symptoms severeness is stagedependent. The presence of the pneumaturia should eliminate differential diagnosis of rectovesical fistula. The association of bladder rupture adds to the complication. It mainly affects older females [1]. The predisposing factors are diabetes and urinary stasis (neurogenic bladder, chronic urinary retention). The most common bacteria are Escherichia coli (58%) and K. pneumoniae (21%). The fermentation of glucose to formic acid during the breathing of bacteria forms carbon dioxide. [2] The CT scan is the first line of investigation, which shows aeric hypodensities and the extension of the lesions. [3] Treatment focuses on parenteral antibiotic therapy with surgical intervention. Despite the 20% mortality rate, outcomes were favorable in most cases. The underlying cause of emphysematous cystitis and its catastrophic consequences affecting the urinary tract necessitates both of urological follow-up and rehabilitation. Keywords Emphysematous cystitis; Perforated bladder; Diabete; Prostate adenoma Disclosure of interest The author has not supplied his/her declaration of competing interest. References [1] Emphysematous cystitis: a review of 135 cases. BJU Int 2007;100:17–20. [2] Gas forming infection of the urinary tract: an investigation of fermentation as a mechanism. J Urol 1990;143(5):960–4. [3] Cystite emphysemateuse aspect scannographique : à propos d’un cas. J Radiol 1993;74:439–40. http://dx.doi.org/10.1016/j.rehab.2016.07.235