Complications and salvage options after laser lithotripsy for a @entity3226 in a tetraplegic XXXX : a case report.

@entity1 @entity3226 @entity1494 @entity548 @entity384 @entity117 @entity1661 @entity5018 @entity281 @entity12805 @entity130
BACKGROUND: Laser lithotripsy of @entity3226 in tetraplegic subjects with long-term urinary catheters is fraught with complications because of @entity1494 , @entity281 , fragile urothelium, @entity1494 , and @entity12805 . Severe haematuria should be anticipated; failure to institute measures to minimise @entity548 and prevent clot retention can be catastrophic. We present an illustrative case. CASE PRESENTATION: A tetraplegic @entity1 underwent laser lithotripsy of vesical stone under general anaesthesia. During lithotripsy, severe @entity1494 and consequent rise in blood pressure occurred. Bleeding continued post-operatively resulting in clot retention. CT revealed clots within distended but intact bladder. Clots were sucked out and continuous @entity1494 was commenced. Bleeding persisted; @entity1 developed repeated clot retention. Cystoscopy was performed to remove clots. @entity1 developed @entity1661 . @entity1494 was suspected; bed-side ultrasound scan revealed @entity384 with mild peritoneal effusion; under-filled bladder containing small clot. @entity1 developed @entity1661 and ileus. Two days later, CT with oral positive contrast revealed intra-peritoneal haematoma at the dome of bladder with perforation at the site of haematoma. Free fluid was noted within the peritoneal cavity. This @entity1 was managed by gastric drainage and intravenous fluids. @entity1 's condition improved gradually with urethral catheter drainage. Follow-up CT revealed resolution of @entity1494 , perivesical haematoma, and intra-peritoneal free fluid. CONCLUSION: If @entity548 occurs, @entity1494 should be commenced immediately after surgery to prevent clot retention. When @entity1494 is suspected, CT of abdomen should be done instead of ultrasound scan, which may not reveal @entity1494 . It is debatable whether laparotomy and repair of @entity1494 is preferable to nonoperative management in tetraplegics. Anti-muscarinic drugs should be prescribed prior to lithotripsy to control @entity1494 ; @entity117 and @entity5018 should be omitted. If significant @entity548 occurs during lithotripsy, procedure should be stopped and rescheduled. Percutaneous cystolithotripsy using a wide channel could be quicker to clear stones, as larger fragments could be retrieved; lesser stimulant for triggering @entity12805 , as it avoids urethral manipulation. But in @entity1 with small, @entity1494 , and protuberant abdomen, percutaneous access to urinary bladder may be difficult and can result in @entity130 .
