A rare complication of intravesical early instillation of mitomycin C after TURBT

Abstract

The early intravesical Instillation of mitomycin C (MMC) is accepted as safe adjuvant therapy after TURBT by non-muscle- invasive bladder cancer if there is no perforation. In our case we report a female patient undergoing resection of papillary recurrent tumor on the anterior bladder wall. In the early postoperative period had the patient no complaints regarding to Instillation of MMC. The clinical manifestation of the necrosis of the anterior bladder wall appeared after one week requiring a long extended unsuccessful conservative therapy in order to save the bladder. Finally we performed a radical cystectomy. This complication is reported by some authors in literature.

Delayed Bladder Perforation Related to Immediate Single Dose Intravesical Doxorubicin Instillation After TURBT: A Case Report and Literature Review

“…This cytotoxic effect was also reported by Tyritzis et al 11 after epirubicin instillation, and by Cliff et al, 8 Nieuwenhuijzen et al, 12 and Hatem and Leifeld 14 after MMC instillation. This cytotoxic effect was recognized herein for the doxorubicin instillation, which is the first time to be reported as a complication of doxorubicin.…”

“…In our case, the patient needed 9 weeks for complete healing after proper open 3 layers bladder wall repair. [7][8][9]13,14 While Lim et al attributed the slow healing in their case to the patient's pre-existing peripheral vascular disease and suboptimal tissue oxygenation, no risk factors were identified in the other cases including our patient who was free of any comorbidities. We suppose that the poor healing is linked to the chemotherapeutic agent inflammatory effect rather than to patient factor.…”

“…4 On the other hand, reporting major complications such as bladder perforation, perirectal abscesses, eosinophilic cystitis, and ureteral stenosis is limited to case reports. [5][6][7][8][9][10][11][12][13][14] In this case, we described our experience with bladder perforation after immediate intravesical instillation of doxorubicin.…”

“…On the other hand, reporting major complications such as bladder perforation, perirectal abscesses, eosinophilic cystitis, and ureteral stenosis is limited to case reports. 5 - 14 …”

Nontoxic Natural Polymeric Particle Vehicles Derived from Hyaluronic Acid and Mannitol as Mitomycin C Carriers for Bladder Cancer Treatment

“…In bladder cancer treatment, surgical transurethral resection of tumorous tissue is the first treatment method, but tumor recurrence is generally seen in most patients within 5 years . Intravesical chemotherapy into the bladder directly by using a catheter as a regional treatment is recommended after transurethral resection to prevent the recurrence and progression of this disease . Nevertheless, cancer drugs such as mitomycin C (MMC) can be absorbed into systemic circulation at a maximum of 5% of the administered dose because the drug is continually diluted and discharged by the urinary system after 2 h due to the limited permeability of urothelium .…”