Bladder rupture

Bladder rupture is a risk of cystourethrography. In two children with myelomeningoceles and ventricnloperito-neal shunts, bladder rupture had particularly serious consequences. The diatrizoate that was used passed into the peritoneal cavity and then via the shunt into the cerebral ventricles and subarachnoid space, causing tonic convnl-sions (SEDA-17, 538). 

This is the most severe type and results in total sacroiliac joint disruption. Features of the Type 1 and 2 pattern may be present. There is widening of the sacroiliac joint and there is diastasis both posteriorly as well as anteriorly due to the posterior sacroiliac ligament rupture. On clinical examination, the hemi-pelvis is unstable in all directions of force and typically requires operative stabilisation. It is possible for the sacroiliac joint to remain intact but there is fracture of the sacroiliac bone. Complications include bladder rupture, and vascular injury (Figs. 12.8,12.9). 

Zaninovic AC, Westra SJ, Hall TR et al (1992) Congenital bladder rupture and urine ascites secondary to a sacrococcygeal teratoma. Pediatr Radiol 22 509-511... 

In case of accumulator failure can be associated to failed valve access oil or air, bladder rupture. 

Coverage confirmation, time to provide full foam coverage, leaks, blockages, rupture disk function, age of foam, portioning calibration mechanisms, performance of delivery pumps or bladder tanks, foam drain times, etc. should be verified for each unique system. NFPA 11 provides guidance in the specific test requirements for several characterisitic foam systems. 

Rogan, M. T. Richards, K. S. (1986). In vitro development of hydatid cysts from posterior bladders and ruptured brood capsules of equine Echinococcus granulosus. Parasitology, 92 379-90. 

Hsu CD, Chen S, Feng TI, Johnson TR. Rupture of uterine scar with extensive maternal bladder laceration after cocaine abuse. Am J Obstet Gynecol 1992 167(l) 129-30. 

Other rare complications have been seldom reported, namely cryoglobulinemia with evidence of disseminated BCG infection (16), ruptured mycotic aneurysm of the abdominal aorta (17), bladder wall calcification (18), rhabdomyolysis (19), iritis or conjunctivitis with arthritis or Reiter s syndrome (20,21), and severe acute renal insufficiency due to granulomatous interstitial nephritis, which can occur even in the absence of other systemic complications (22). 

A 71-year-old man with bladder carcinoma in situ received six instillations of BCG at weekly intervals followed 3 months later by three booster instillations at weekly intervals. Four months later an inflammatory aortic aneurysm, which had ruptured into a pseudoaneurysm, was diagnosed and excised. Mycobacterium bovis was found. After treatment with isoniazid and rifampicin he recovered. There was no sign of tumor in the bladder at cystocopy 8 months after the last BCG instillation. 

Isotonic (0.9%) sodium chloride is used commonly as an intraoperative intravenous (i.v.) replacement fluid in species other than the horse. Isotonic sodium chloride has a higher ratio of chloride to sodium than plasma and, therefore, reduces the strong ion difference and causes mild hyperchloremic acidosis in normal ponies (Gossett et al 1990a). This limits its utility as a resuscitation fluid in the horse, as most horses requiring fluid resuscitation already have acidosis. Isotonic sodium chloride should not be used for resuscitation unless indicated by measured electrolyte abnormalities. A possible exception is in foals with ruptured bladders, which are highly likely to be hypochloremic, hyponatremic and hyperkalemic. 

Sodium chloride solution has been advocated in hyperkalemia, in order to avoid the potassium-containing polyionic fluids (Table 17.4). However this does not apply to the horse in the absence of clinical signs of hyperkalemia and with the exception of horses with hyperkalemic periodic paralysis or with a ruptured bladder, the hyperkalemia is likely to reflect acidosis and polyionic fluids are probably appropriate. 

Because of the risks associated with rapid changes in plasma osmolality (Adrogue Madias 2000a), 7% saline should probably not be administered to neonatal foals. The author has used 1.8% saline in foals with ruptured bladders (which are hyponatremic and hypochloremic) with apparently good clinical results. 

Hyperkalemia may occur in acidosis, colitis, ruptured bladder and renal failure and in horses... 

Note (1) Number of animals in experiment (2) number of being injured (3) myocardial blooding (4) myocardial necrosis (5) mild (6) medium (7) severe (8) mild (9) medium (10) severe (11) empsyxis (12) ruptured ear drum (13) blooding of other organs (14) bladder (15) stomach (16) epinephros (17) spleen (18) brain (19) severe (20) medium (21) mild (22) no... 

Osmosis, or the net transfer of solvent from a dilute to a more concentrated solution across a suitable membrane, had been known since 1748 when the Abbe Jean Antoine Nollet (1700-1770) noticed that a pig s bladder covering a container of alcoholic solution was ruptured when immersed in water. The phenomenon of osmosis could only be studied properly when sufficiently strong membranes could be produced to withstand the pressure generated. It was Moritz Traube (1826-1894) who discovered in 1867 that a strong membrane could be prepared by precipitating copper ferrocyanide in the walls of a porous pot. He was able to show that for a given solution osmosis occurred until a certain pressure was reached, which is called the osmotic pressure of the solution. In 1877 the German botanist... 

Mineral deposits which occur in the urinary tract. These deposits may block the flow of urine, followed by rupture of the urinary bladder and death. In severe cases of some duration, watery swellings (edema) of the lower abdomen may develop. 

Extremely rare in childhood, the urethral polyp is usually solitary and consists of a pedunculated structure, originating from the posterior urethra, developing in the bladder neck, which can prolapse in the urethra during micturition (Foster and Garrett 1986). Hematuria, nonneurogenic bladder-sphincter dysfunction and infection may reveal the abnormality. On ultrasound, it appears echo-genic. The main differential diagnosis of urethral polyp is an ectopic ureterocele that has ruptured either spontaneously (Fig. 6.8) or after endoscopic... 

Fig. 6.8. Sagittal US view of the bladder neck in a male neonate with left duplicated ureter. The echogenic mass visible in the bladder neck is a spontaneously ruptured ectopic ureterocele, draining the dysplastic upper pole of the duplicated left kidney. Urethral polyp is the main differential diagnosis...

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