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Point of Technique Conservative Management of Early Bladder Rupture After Postoperative Radiotherapy for Prostate Cancer ‘Abbas Basir, Mohammad Hadi Radfat INTRODUCTION Pelvic radiation is cause several complicit jnvolving winary bladder such asradiation cystitis, uleeration, and incontinence." Spontaneous intraperitoneal euptre of the urinary blader is a rare complication following pelvic itradation.*® To the best of our knowledge, theres only one report of radationinduced blader rupture following irradiation for prostate cancer which was managed surgically." Here, we preseat a case of spontaneous intraperitoneal Uae pce acer oats after adjuant radiotheeipy for prostate cance hat was sucessfully managed conservatively. CASE REPORT fe report ‘normal bowel function and denied y abdominal trauma. He bad undergone radical prostatectomy for prostate adenocarcinoma (Clinical stage, T20), 2 years earlier Due to an increas in Serum prostatespecifc antigen level, he had also received postoperative ternal pelvic irradiation 8 id babar “ewan to "Eon gun ination coerce, consisted of L2 Gy per altoehoadtes day, 5 daysa week, to total of olay Joma | es | Nos | Au 2000, 72Gy. Then, he had develope 2s masive fibrotic sue over the ssprapubic region and suffered frou wild obstructive symptoms au fequency. Onadnision, the patient was alerile. His abdomen ‘i lly distended without generalize tenderness, Bowel sounds were diminished. There vis marked tenderness without rebound tenderness and guarding ‘over the lower abdomen. ‘The blader was catheterized and about 70 mi. of bloody urine was ‘obtained. Daily urinary vole ‘vas uoratal. Serum prostatespecitic antigen, serum creatinine and blood tured nitrogen remained within the normal range. Ulrasonogeaphy examination revealed a small amount of intrrabdonsinl id Since abdominal pain improved gradually after catheterization, cystoscopy and eystography were performed to examine the Dladéer. Since the Bladder neck ws severely elevated on eystoscopy, catering the Bladder wis very difficult. Cystoscopie examinat showed a low.voluane bladder with edematous inflamed mucosa, bat uo point of perforation was diagnosed ‘Cystogeaphy showed exteavasition ‘of the contrast medi into the peritonesl cavity (Figate 1). Hence, spontaneous intraperitoneal rupture ofthe urinary bladder was diagnose. 269| Diskusi (Hasil feedback dari pembimbing) Pugh nce trmans tapas Atmuhin pede bart rare Iihas Hyde damimye oh Laban Mone Eales pele permed da ils) dhupes Sears Sperber - Gye ay pada rue vance Urner cdblah himating mabaskepis Replor vera. Unnane ditenanbes taedosurban twpat [liken hyichaye etshuasen lon dabidaken mind? (Wrapehral dev dbstapgabesal Unbrnertinea! 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Baddic Popkut WV Ginsbatitnary frag s the Mqicites Pe oman adie CO) Sheuabamane, Snyay 2atd: Blair Trou In Bott Qrunpray Madcon Bab Yeie, URETERALTRaUhen nical Features Se maps - aoa a hey aca Sh hymen fetes rat na Cnc renee Par Thome ne ore “ it ba er at roca ni Mtl af re, ee cut eae xa ota etc et Sa Som ay erecta ee oe auraay ba en Dit gr ‘peas at ait oe erat een apiece dn yd compa a ath eee Diagnostic Tasting He 1Y Pyelograpiyuroprapty “Riven tmnt roe indy CF caning sth CF na ene ie ‘Sat arte advan of content ch prey ms viata leveeratee ale snendl ert cece ons iS com wate sae itsce a a tanevens process acu prmephrc sandng Salat eer a iar ia onareaecriere Serratia cieenaree nie pi Akers pe pep cae Management Wah iain nding contin and parton ‘eel ening is tpl ace How cat (npn ake prc earsene tne ater and wer cpanel, Nee {omy trate bu Sores sey ene pon ‘neu te div npn she ‘Spat wo lwo he ted se Uy es ng ‘2p rs ell ues song he mot SE oie Cong i Seu iden) Cetera Yume Say fe 18-36, rane omplation wat eget se when dois sey le BLADDER TRAUMA nial Features Diferenial Diagnosis ‘iieniting npn Fon TBR of eno ing ‘ptm ra moe ey pean Sc stron ore spe eh tended ferme rus Boi is ema anges era Kons agen-eagdcoptis of e idea ong ape Diagnostic Testing ‘ta ais bona ration ot lin dg ‘int Walder uy’ bento penn tema. ‘Syotcnen ho wean go eran ae mec nor High cy pov Nowe Fagen (naoant2?me ed apr ote th pe cso onc syn slp ee ‘Stee obec hn apr fs moa sh ‘tne tn a hn oe mt ted BK Ope str eter sal tp inna ha ‘evsios flowing By deeting te Naaru at ayo ray tac et ican ed eva fomed slog he Mer val weds ang hom pronaEoptnoed ne om Ka el ina e cde saca frm owen arf br ce sma eae, ems rier dig ade ramen oe ‘ook inaicen tai none td crea ee” ‘Epi pn ctr ‘cava une nc i ap ro er i urna a ot ben yet anes URETHRAL TRAUMA Sinan cca th yy lnk fetes reentry Th ni? 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