[Secondary bladder amyloidosis with severe recurrent hematuria: transurethral Mickuliz procedure as hemostatic option].
OBJECTIVE
Primary localized amyloidosis of the urinary bladder generally has a benign course. On the contrary, secondary amyloidosis, a consequence of systemic amyloidosis, may have massive bleeding and produce complications such as bladder rupture or life-threatening hemodynamic problems requiring desperate hemostatic procedures such as hypogastric artery embolization or ligature, or cystectomy. We report one case in which hemostasis was achieved by a Mickulicz transurethral bladder tamponage.


METHODS
58 year old female with very aggressive rheumatoid arthritis and secondary renal amyloidosis under chronic hemodialysis presenting with severe hematuria after hip replacement. An inflamed bladder was found, the biopsy of which showed edema in all layers with blood vessel walls enlarged by amiloyd deposits. After several unsuccessful transurethral hemostatic procedures, intravesical formalin irrigation was carried out together with a Mikulicz type gauze packaging after urethral dilation. The gauze was withdrawn three days later without bleeding recurrence; however she presented subsequent neurological impairment and finally died 14 days after the last urological procedure.


CONCLUSIONS
Transurethral packaging of the urinary bladder in a woman with massive hematuria is a hemostatic option that we recommend to be used before other more dramatic or invasive options are chosen.
Cánovas Ivorra
José Antonio
JA
Cátedra y Servicio de Urología, Hospital Universitario San Juan, Alicante, España. jacanovas@hotmail.com
Prieto Chaparro
Luis
L
Rodríguez Fernández
Elena
E
López López
Cristóbal
C
Quílez Fenoll
José Manuel
JM
Romero Maroto
Jesús
J
D000686:Amyloidosis / Q000150:complications*; D005260:Female; D006417:Hematuria / Q000209:etiology* / Q000628:therapy*; D006489:Hemostatic Techniques; D006801:Humans; D008875:Middle Aged; D012720:Severity of Illness Index; D014521:Urethra; D001745:Urinary Bladder Diseases / Q000150:complications* / Q000628:therapy*