Post-op complication: bladder rupture

Jim

That's crazy. No, I've never heard of that happening. It's good that the docs at the hospital you went to were able to patch you up--and that the surgeon had a relationship with the doc at MSK. What causes it?

What a terrible experience that must have been. Hope you are recovering well.

Very, very scary!
Just imagine this would have happened far away from a qualified (!) medical facility...
Hope your recovery will be uneventful.

Herophilus said...
Your bladder didn't rupture. It was injured during the surgery that's called iatrogenic surgical injury.it wasn't noticed. It wasn't on purpose. It had been leaking very slowly until the injury expanded the night you started having problems. Bladders don't just spontaneously explode in healthy men. If your bladder had cancer or some other corrosive disease??? Its just not something that happens. You should have been told that.
Hero

Very good point! Although I would like to hear the rebuttal from the surgeon.
Unfortunately, it's mostly 'academic' by now.

Post Edited (Sr Sailor) : 3/4/2019 5:57:40 PM (GMT-7)

It could also have been injured by the Foley catheter. There are reports in the medical literature of ruptured bladder from difficulties with Foley placement. But it's very rare, and in your case even less likely because you didn't have symptoms for 2 months after the Foley was removed.

Oh Contraire BlackJack. If you would be so kind as to revisit Jim’s original post he indicated that the emergency surgical team described a finding of a “1.5cm Cut” in his bladder. Operative word cut. Your comments as to the description of “rupture” are spot on. However Jim said that his surgical team described a cut, not a “break or tear”

Which is why I started my post with the sentence “your bladder didn’t rupture”.
Obviously the original injury, went unnoticed. It happens... During this type of surgery a bladder or bowel injury is a known complication and the bladder injury in particular is easily repaired. I just don’t think that Jim got complete disclosure, which is all I would ask given the same situation.
Hero

A belated but much appreciated thanks for the discussion. The surgeon isn't admitting it was iatrogenic. He believes it is too distant from the procedure (Nov 7, LARP -> Feb 24, Bladder emergency). However, I believe it started before. At the 6 wk point after surgery I asked the surgeon if I could resume exercising and he said yes, "it's six weeks" (last week in Dec.) I decided to wait two more weeks until mid-January before resuming back and ab exercises.

On January 17 I noticed all my surgical incisions were weeping clear liquid and my mid-abdomen had swelled and was inflamed. At the same time I had a dermatological outbreak with blisters on all my limbs. I assumed it was an allergic reaction but my allergist had me see a dermatologist immediately. The Derm had a biopsy to test for all types of viruses and autoimmune disease. As the biopsy showed nothing she gave me antibiotics and that stopped the inflammation but not the dermatological outbreak.

I contact the LAPR surgeon and he looked at the photos and said it was dermatological and awaited the biopsy for confirmation. Since the surgery wounds had dried-up I too assumed it was dermatological. The dermatologist wasn't so sure. She said the secondary dermatological blisters all over my body could be an "id reaction" also known as an autoeczematization in response to the original surgical wound outbreak.

After my bladder rupture, the surgeons in the hospital wanted to know about the dermatological blisters and had the hospitals dermatologist (actually resident) examine me and he came to the same conclusion: it was an id reaction. The mechanism for an id reaction isn't known but if the original disturbance is removed, the skin clears up--which it did. Thus, the bladder was leaking for at least a month from Jan 17 to Feb 24 when I went to the emergency room. Clearly the 1.5 liters of urine that they removed from the abdomen had been collecting for some time.

The timeline looks like a continuum, not a delayed reaction after 4 months. I suspect it was iatrogenic but perhaps it was a nick. Might it not even self-cured at first, as muscles tend to do? Perhaps a resumption of exercise interrupted that process? In any case I find it hard to believe that the bladder just ruptured. Of course, there's always a possibility of another disease. Perhaps I should pressure them to look for that if they insist it isn't related to the surgery.

jasperx10 said...
When you get a scratch, nick on your bladder during surgery you need to have a catheter in longer to allow the bladder to heal. ... My money is you got a nick in surgery and it never had a chance to fully heal.

I think you're are right, it has the sign of being a nick. Interestingly enough, one surgeon, whom I consulted for a 2nd opinion, said he always leaves the catheter in for two weeks.

jasperx10 said...
I wonder if an advantage of open surgery is it's all spread out in front of the surgeon (manner of speaking ) so any nicks are more likely to be spotted ?

I wondered about that, too. The old-timers who do open surgery boast about have a tactile sense. The LARP docs reply that you only need a tactile sense because you can't see. Supposedly the optical sensors can be moved around and I assume amply the object.

The irony is that I wound up having open surgery for the bladder operation. If you add up the length of the 6 incisions for LARP it equals the length of the open surgery incision.

By the way, bladder ruptures are fixed without surgery. The attending surgeon who did my bladder surgery said he usually (for example, from an auto accident) just puts a catheter in for two weeks and the bladder heals. In my case, he decided surgery was needed. He also consulted with my prostate surgeon first. It turns out he had once trained under my prostate surgeon and had his personal cell phone number. The rupture turns out to be in the back of the bladder in a hard to reach place. Perhaps a sense of touch would have found it.