Perivesical Inflammation and Necrosis due to Mitomycin C Instillation after Transurethral Resection of Bladder Tumor: We Must Be Vigilant!

Fazlıoğlu, Adem; Tandoğdu, Zafer; Kurtuluş, Fatih; Parlakkılıç, Oğuzhan; Çek, Mete

doi:10.1159/000241684

Cited by 7 publications

(7 citation statements)

References 13 publications

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“…While early radical cystectomy can provide an overall survival benefit, this approach if applied in all patients would constitute overtreatment for many, unnecessarily exposing them to undue risks of complications and impaired quality of life (12). Furthermore, although radical cystectomy is the indicated treatment for localized high‐grade muscle‐invasive tumors, the decision to provide adjuvant or neoadjuvant chemotherapy in this group remains controversial and also exposes patients to associated toxicity (13–15). Therefore, there is a strong need for an improved ability to predict the course of disease in individual patients in order to optimize treatment selection strategies.…”

Section: Discussionmentioning

confidence: 99%

High‐grade bladder cancer: Association of the apparent diffusion coefficient with metastatic disease: Preliminary results

Rosenkrantz

Mussi

Spieler

et al. 2012

Magnetic Resonance Imaging

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Purpose: To assess the utility of apparent diffusion coefficient (ADC) values obtained from diffusion-weighted imaging (DWI) in distinguishing high-grade bladder cancer with and without metastatic disease. Materials and Methods:Seventeen patients with histologically confirmed high-grade bladder cancer who underwent pelvic magnetic resonance imaging (MRI) at 1.5T including DWI using b-values of 0, 400, and 800 sec/ mm 2 were assessed. Histologic findings and follow-up imaging were used to establish the reference standard in terms of metastatic disease. Two radiologists independently recorded ADC of all lesions following a training session, with their results averaged. Mann-Whitney U-test, receiver operating characteristic (ROC) curve analysis and intraclass correlation coefficient (ICC) were used for data analysis.Results: Metastatic disease was characterized as present or absent in eight and nine patients, respectively. ADC was significantly lower among cases with metastatic disease than among cases without metastatic disease, both within the entire cohort (1.07 6 0.18 Â 10 À3 mm 2 /s vs. 1.45 6 0.22 Â 10 À3 mm 2 /s; P ¼ 0.002) and within the subset of patients with muscle-invasive tumor (1.06 6 0.19 Â 10 À3 mm 2 /s vs. 1.45 6 0.23 Â 10 À3 mm 2 /s; P ¼ 0.017). Area under the ROC curve for identifying metastatic disease using ADC was 0.944, with optimal threshold of 1.21 Â 10 À3 mm 2 /s, which was associated with a sensitivity of 87.5%, specificity of 100%, positive predictive value of 100%, and negative predictive value of 90.0%. Interreader agreement for ADC was excellent (ICC ¼ 0.91). Conclusion:In this preliminary study, ADC was significantly different between cases of high-grade urothelial carcinoma of the bladder with and without metastatic disease. These results may have value in assessing the metastatic potential of patients with localized high-grade tumors of the bladder.

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Section: Discussionmentioning

confidence: 99%

High‐grade bladder cancer: Association of the apparent diffusion coefficient with metastatic disease: Preliminary results

Rosenkrantz

Mussi

Spieler

et al. 2012

Magnetic Resonance Imaging

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“…Some reports have revealed the causes of bladder perforation, including TURBT, interstitial cystitis, neurogenic bladder, radiation cystitis, bladder cancer and an indwelling urethral catheter [9][10][11]. Recently, bladder perforation associated with instillation of intravesical mitomycin C (MMC) after TURBT was reported [12,13]. However, there have been no reports of bladder perforation associated with intravesical instillation of BCG.…”

Section: Discussionmentioning

confidence: 99%

“…In our patient, since cystoscopy before the 1st treatment with BCG revealed no apparent cause of perforation, bladder perforation was not suspected at the 1st BCG treatment. Inflammatory changes induced by BCG treatment in the area of the TURBT might cause ischemic changes leading to the development of bladder perforation similar to MMC [12,13].…”

Section: Discussionmentioning

confidence: 99%

A case of ureteral obstruction and sepsis induced by bladder perforation following intravesical bacillus Calmette–Guérin successfully treated with an antituberculous agent, antimicrobial chemotherapy and percutaneous urine drainage

et al. 2018

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We report a case of ureteral obstruction and sepsis induced by bladder perforation following intravesical bacillus Calmette-Guérin (BCG) that was successfully treated non-surgically. A 56-year-old man was diagnosed with non-muscle invasive bladder cancer. He was treated with intravesical BCG instillation after transurethral resection of the bladder tumor. Just before the 6th course of intravesical BCG, the patient was diagnosed with bladder perforation and developed ureteral obstruction and sepsis associated with BCG. He was treated successfully with an antituberculous agent, antimicrobial chemotherapy and percutaneous urine drainage. Bladder perforation associated with BCG is a very rare adverse event that causes severe sepsis.

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“…Perivesical inflammation and necrosis, 3 necrosis of the glans penis 4 and urethra, 5 ureteral stricture development, 6 allergic reactions and bladder wall calcifications 7 are rarely declared side effects. These complications are often reported as an adverse effect of immediate postoperative MMC instillation.…”

Section: Discussionmentioning

confidence: 99%

Distal ureteral stricture: A unexpected complication of further adjuvant intravesical mitomycin C thermotherapy

Umul

Altok

Güneş

et al. 2014

CUAJ

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We present a case of distal ureteral obstruction in relation to further adjuvant intravesical thermochemotherapy with mitomycin C (MMC) for non-muscle invasive bladder cancer (NMIBC). We also discuss the diagnostic procedures and management of this recurrent case. IntroductionTransuretral resection of the bladder tumour (TURBT) is still recognized as the primary treatment option for non-muscle invasive bladder tumours (NMIBT). However, recurrence and progression are still issues despite the radical resection. The European Association of Urology (EAU) has recommendations regarding adjuvant intravesical chemotherapy in relation to risk group stratification of NMIBC.1 Mitomycin C (MMC) is one of the commonly used agents for further adjuvant intravesical treatment of intermediate and highrisk NMIBT. Moreover, adjuvant thermochemotherapy with MMC has been presented as a hopeful treatment option for further intravesical therapy in patients with high-risk tumours.2 In this report, we present a case of a ureteral orifice and distal ureter stenosis developed after adjuvant intravesical therapy as a potential side effect of MMC thermotherapy. Case reportA 65-year-old man underwent TURBT for a primary, highgrade, NMIBT (pT1G3) localized at the junction of the bladder base and left lateral bladder wall, about 2 cm away from the left ureteral orifice. The resection did not include the left ureteric orifice region and both the bladder wall and orifice were intact after resection. One early intravesical instillation of 40 mg MMC in 50 mL saline was administered postoperatively. The convalescence period was uncomplicated. A secondary resection was performed 4 weeks after the primary resection and the pathological assessment revealed inflammatory reactive changes with infiltration of eosinophils and giant cells. Ultrasonographic evaluation of the urogenital tract was normal 2 months after the primary resection. In light of the pathological evaluation of the primary tumour, we planned to administer further adjuvant intravesical immunotherapy with Bacillus Calmette-Guérin (BCG). However, the patient was unable to supply the BCG preparations. Therefore, we decided to continue further adjuvant intravesical treatment with MMC thermochemotherapy.After the decompression of the bladder, the thermotherapy was administered with the usage of the bladder wall thermochemotherapy (BWT) system (Pelvix TT system, Elmedical Ltd., Hod Hasharon, Israel) by insitillation of 40 mg MMC in 50 mg distilled water for 50 minutes with uniform 44°C temparature on the bladder wall. This induction therapy was performed weekly for 6 weeks. The patient then complained about ambiguous flank pain on the left side after 6 doses of thermochemotherapy. The ultrasonografic evaluation of the kidneys revealed a mild-to-moderate dilatation of left ureter and collecting system. Non-contrast and contrast-enhanced abdominal computed tomography scan confirmed left hydroureteronephrosis without concomitant urinary stones (Fig. 1). Transurethral resection of the obst...

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Perivesical Inflammation and Necrosis due to Mitomycin C Instillation after Transurethral Resection of Bladder Tumor: We Must Be Vigilant!

Cited by 7 publications

References 13 publications

High‐grade bladder cancer: Association of the apparent diffusion coefficient with metastatic disease: Preliminary results

High‐grade bladder cancer: Association of the apparent diffusion coefficient with metastatic disease: Preliminary results

A case of ureteral obstruction and sepsis induced by bladder perforation following intravesical bacillus Calmette–Guérin successfully treated with an antituberculous agent, antimicrobial chemotherapy and percutaneous urine drainage

Distal ureteral stricture: A unexpected complication of further adjuvant intravesical mitomycin C thermotherapy

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