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Abstract
RESUMENIntroducción: La hematuria macroscópica masiva es una urgencia urológica de alto riesgo, especialmente cuando se asocia a retención urinaria por coágulos, anemia severa, inestabilidad hemodinámica y necesidad de intervención urgente. Su manejo requiere estabilización precoz, drenaje vesical efectivo, control del sangrado y pesquisa oportuna de complicaciones. Se presenta un caso de hematuria masiva refractaria complicada con hemovejiga, shock hipovolémico y perforación vesical.
Presentación del caso: Paciente masculino de 70 años, con hipertensión arterial, tabaquismo activo y antecedente de cáncer de próstata tratado con radioterapia hace 15 años, consultó por hematuria intermitente de un mes, nicturia, dolor genital y baja de peso. Evolucionó con hematuria franca, retención urinaria, hemovejiga masiva, hemoglobina de 5,5 g/dL y shock hipovolémico. Tras intentos de cateterización, sonda vesical de tres vías y lavado manual, se evidenció líquido libre intraabdominal. La UroTC confirmó perforación vesical probablemente iatrogénica, por lo que se realizó laparotomía exploradora, cistotomía, evacuación de coágulos y rafia vesical. Posteriormente persistió con hematuria refractaria y altos requerimientos transfusionales. La AngioTC descartó sangrado arterial activo. Se efectuó cistoscopía con evacuación de aproximadamente 1000 cc de coágulos, hemostasia de vasos friables de neoformación y resección de lesiones eritematosas, compatibles con cistitis actínica hemorrágica.
Resultados: El paciente evolucionó favorablemente, con estabilidad hemodinámica, orinas claras, ausencia de nuevo sangrado, recuperación hematológica y alta con seguimiento urológico ambulatorio.
Discusión: El caso evidencia una forma grave de hematuria refractaria secundaria a vejiga irradiada, donde el manejo endoscópico permitió controlar el sangrado evitando embolización o cistectomía.
ABSTRACT
Introduction: Massive gross hematuria is a high-risk urological emergency, particularly when associated with clot retention, severe anemia, hemodynamic instability, and the need for urgent intervention. Management requires early stabilization, effective bladder drainage, bleeding control and timely detection of complications. We present a case of refractory massive hematuria complicated by massive intravesical clot burden, hypovolemic shock, and bladder perforation.
Case presentation: A 70-year-old male patient with hypertension, active smoking, and a history of prostate cancer treated with radiotherapy 15 years earlier presented with a one-month history of intermittent hematuria, nocturia, genital pain, and weight loss. He progressed to gross hematuria, urinary retention, massive intravesical clot burden, hemoglobin of 5.5 g/dL, and hypovolemic shock. After catheterization attempts, placement of a three-way Foley catheter, and manual bladder irrigation, intra-abdominal free fluid was detected. CT urography confirmed a likely iatrogenic bladder perforation, and the patient underwent exploratory laparotomy, cystotomy, clot evacuation, and bladder. Persistent refractory hematuria with high transfusion requirements followed. CT angiography excludes active arterial bleeding. Cystoscopy was performed, with evacuation of 1000 mL of clots, hemostasis of friable neovascular vessels, and resection of erythematous lesions, consistent with radiation-induced hemorrhagic cystitis.
Results: The patient achieved hemodynamic stability, clear urine output, absence of recurrent bleeding, hematologic recovery, and favorable clinical evolution, allowing discharge with outpatient urology follow-up.
Discussion: This case illustrates a severe form of refractory hematuria in a previously irradiated bladder, in which endoscopic management successfully controlled the bleeding and avoided embolization or cystectomy.
Keywords (MeSH): Hematuria; Radiation Cystitis; Urinary Bladder Diseases; Shock, Hemorrhagic; Cystoscopy.
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Copyright (c) 2026 María Trinidad Morales Retamales, Camila Ignacia Reyes Maze, Magdalena Ximena Julio Iturrieta, María Camila Court Larraín, María Paz Uarac Loayza, Paula Fernanda Ebensperger Escalona, Felipe Ignacio Avaca Rodriguez (Autor/a)