Extravasation of Intravesical Chemotherapy for Non-Muscle-Invasive Bladder Cancer

Abstract

Purpose: To report our experience with symptomatic extravasation of intravesical chemotherapy administered within 24 h after transurethral resection (TUR) over the past 10 years. Methods: We identified all consecutive patients who presented with symptomatic extravasation of intravesical chemotherapy following TUR between 2001 and 2011. We assessed the severity of the postoperative complications using the modified Clavien system. Results: We identified 9 patients (mean age 59, range 40–76 years) with symptomatic extravasation. One patient had grade II, 2 had grade IIIa, and 5 patients had grade IIIb complications according to the Clavien system. Surgery was needed in 6 of 9 patients. One required ICU management (Clavien IV). No patients died in the postoperative course. Conclusion: Extravasation can cause severe complications and diagnosis is often protracted. Considering the growing practice of immediate intravesical instillations, the number of patients with symptomatic extravasation is expected to rise. An increased awareness of this possible complication is warranted.

Low Risk of Severe Complications After a Single, Post-Operative Instillation of Intravesical Chemotherapy in Patients with TaG1G2 Urothelial Bladder Carcinoma

“…Also, part of the urologists doubt the efficacy of SI [ 12, 13, 24 ] although a meta-analysis by Sylvester et al reported a recurrence rate of 44.8% in the SI group versus 58.8% in the TURBT only group [ 2 ]. But the most important factor seems to be the risk of severe or even deadly complications caused by administering SI after unobserved perforation of the bladder [ 25 ]. This concern is based on studies showing a high risk of extravasation, as for example shown by a prospective study of Balbay et al from 2005.…”

Interobserver variability of Clavien–Dindo scoring in urology

“…showed that CDc use in papers reporting on complications by standardized criteria increased from 0% in 1999–2000 to 62.1% in 2009–2010 . In urological papers, the use of classification is not so common, but the CDc has already been used in current urological literature considering the complications of endoscopic (laparoscopic radical prostatectomy, percutaneous nephrolitotripsy, ureterorenoscopy, transurethral resection of bladder tumor, transurethral resection of prostate or laser vaporization of prostate) and open procedures (radical cystectomy), allowing for direct comparison to other techniques and aiming at further reduction in complications in the future …”