Pseudo-renal failure: bladder rupture with urinary ascites.

Area of Science:

• Urology
• Nephrology
• Radiology

Background:

• Transurethral resection of bladder tumor (TUR-BT) is a common urological procedure.
• Bladder rupture is a rare but serious complication following TUR-BT.
• Pseudo-renal failure presents as elevated creatinine and hyperkalemia with normal kidney function.

Observation:

• A 63-year-old male presented with abdominal distension and ascites.
• Laboratory tests revealed elevated serum creatinine and hyperkalemia.
• Ascitic fluid analysis showed urea, creatinine, and potassium levels higher than serum levels.

Findings:

• CT scan and cystography indicated bladder wall thinning and fragility at the TUR-BT site.
• Diagnosis of pseudo-renal failure due to urinary ascites and reverse intraperitoneal dialysis was established.
• Urinary catheterization led to prompt improvement in symptoms and laboratory abnormalities.

Implications:

• This case underscores the importance of considering urinary ascites in patients with a history of genitourinary procedures or trauma presenting with ascites and elevated creatinine.
• Early recognition and management, such as urinary catheterization, are crucial for resolving pseudo-renal failure caused by urinary ascites.
• Increased awareness among clinicians can prevent misdiagnosis and delayed treatment of this rare complication.