CASE 33: Unsynchronized Urinary Bladder Pacer

Female in her 70s with a long history of atonic bladder treated with a bladder pacemaker. Presented with a urinary tract infection 5 years after deceased donor kidney transplantation. Ultrasound evaluation showed hydronephrosis (orange arrows).

A percutaneous nephrostomy study showed passage of contrast into the bladder (pink arrows) with a questionable narrowing (yellow arrows) in the distal transplant ureter. A nephrostomy tube (white arrow) was left in place. The bladder pacemaker (green arrows) was subsequently re-programmed and the nephrostomy tube capped. A repeat ultrasound study 4 days later showed resolution of the hydronephrosis. The nephrostomy tube was removed. This recipient’s findings were attributed to a malfunctioning bladder pacemaker.

A percutaneous nephrostomy study showed passage of contrast into the bladder (pink arrows) with a questionable narrowing (yellow arrows) in the distal transplant ureter. A nephrostomy tube (white arrow) was left in place. The bladder pacemaker (green arrows) was subsequently re-programmed and the nephrostomy tube capped. A repeat ultrasound study 4 days later showed resolution of the hydronephrosis. The nephrostomy tube was removed. This recipient’s findings were attributed to a malfunctioning bladder pacemaker.

A percutaneous nephrostomy study showed passage of contrast into the bladder (pink arrows) with a questionable narrowing (yellow arrows) in the distal transplant ureter. A nephrostomy tube (white arrow) was left in place. The bladder pacemaker (green arrows) was subsequently re-programmed and the nephrostomy tube capped. A repeat ultrasound study 4 days later showed resolution of the hydronephrosis. The nephrostomy tube was removed. This recipient’s findings were attributed to a malfunctioning bladder pacemaker.