Bladder irrigation and urothelium disruption: A reminder apropos of a case of fatal fluid absorption

Background: Irrigation or washouts of the bladder are usually performed in various clinical settings. In the 1980 Elliot and colleagues argued that urothelial damage could occur after washouts and irrigations of the bladder. Th exact mechanism underlying urothelial damage has not yet been discovered. To our knowledge, this is the first repor of fatal fluid overload and pulmonary edema, due to urothelium disruption occurring during bladder irrigation approached performing complete histological and immunohistochemical investigation on bladder specimens The exposed case deserves attention since it demonstrates that, although very rarely, irrigation or washouts o the bladder may have unexpected serious clinical consequences Case presentation: An 85 year-old Caucasian man, unable to eat independently and whose fluid intake was controlled underwent continuous bladder irrigation with a 3-way catheter due to a severe episode of macrohematuria. Durin the third day of hospitalization, while still undergoing bladder irrigation, he suddenly experienced extreme shortnes of breath, breathing difficulties, and cough with frothy sputum. His attending nurse immediately noted that there wa no return of the fluid (5 liters) introduced through bladder irrigation. He was treated urgently with hemodialysis. A the beginning of the dialysis treatment, the patient had gained 7.4 kg since the previous measurement (24 hours prior without any clear explanation. Although a significant weight loss (from 81 to 76 kg) due to the dialysis procedure the patient died shortly after the final treatment. The autopsy revealed that the brain and the lungs were heavil edematous. Microscopic examination of bladder specimens revealed interstitial and mucosal swelling, and loss o the superficial cell layer. Intermediate and basal urothelial cells were preserved. Altogether the abovementione findings were suggestive of a diffuse disruption of the urothelium. In conclusion the death of the man was attribute to an acute severe pulmonary edema due to massive fluid absorption Conclusion: Our case demonstrates that urothelium disruption may occur during irrigation and washouts of th bladder, also in the absence of other well-known predisposing conditions. Inappropriate use of bladder irrigatio should be avoided and a close attention is required of the fluid balance is mandatory when irrigating the bladder Keywords: Bladder irrigation, Fluid absorption, Pulmonary edema, Urothelium disruption.