MIGRATION OF A PROSTHETIC ACETABULUM INTO THE BLADDER

A 71-year-old woman was referred to us with a 4-month history consistent with cystitis and lower urinary tract infection. Cultured urine had grown Escherichia coli but the symptoms failed to resolve despite appropriate antibiotic therapy. Medical history was significant and complicated. In 1981 total abdominal hysterectomy and bilateral oophorectomy were performed for carcinoma of the ovary. Adjuvant external beam radiotherapy and chemotherapy were administered. In 1986 pelvic recurrence necessitated further chemotherapy and irradiation. Two years later a right total hip replacement was performed for osteoarthritis and convalescence was uneventful. Complications arising from small and large bowel radiation enteritis required laparotomies in 1989 and 1995, and a defunctioning loop colostomy was fashioned. Bowel dysfunction did not recur. Our initial urological evaluation began in March 2000. The patient presented with severe dysuria, frequency of small volumes of urine, urgency and nocturia with no relief achieved with antibiotic or anticholinergic therapy. Midstream urine culture yielded mixed growth only. A scout film demonstrated the prosthetic acetabulum in a mid pelvic location (fig. 1, C). The remainder of the urogram was normal. Sequential plain hip and pelvic radiography illustrated the timely transpelvic migration of the acetabulum into the bladder (fig. 1). Cystoscopy confirmed the diagnosis and the foreign body was removed at open surgery (fig. 2). Convalescence was uneventful with a dramatic resolution of symptoms. DISCUSSION