Transurethral resection of bladder tumour complicated by perforation requiring open surgical repair – clinical characteristics and oncological outcomes

Abstract

Study Type – Therapy (case series) Level of Evidence 4 What’s known on the subject? and What does the study add? Evidence suggests that open repair of a bladder perforation during TURBT may increase the risk of pelvic or distant disease recurrence. The study demonstrates that while bladder violation during TURBT may carry a potential for considerable morbidity, it does not seem to substantially increase the risk of extravesical tumour seeding and disease recurrence. OBJECTIVE • To examine the clinical characteristics and long‐term outcomes of patients with bladder perforation requiring open surgical repair as a complication of transurethral resection of bladder tumour (TURBT). PATIENT AND METHODS • A search of our institutional database yielded 4144 patients who underwent TURBT from 1996 to 2008, of whom 15 (0.36%) required open surgical intervention to repair a large bladder perforation. • In all cases, a filling cystogram was performed before laparotomy. Clinical, pathological and follow‐up data were reviewed, and the incidence and time of extravesical tumour recurrence were recorded. RESULTS • Median patient age was 77 years. Intraperitoneal perforation was diagnosed in 12 patients, generally involving the posterior wall. Concomitant bowel injury was identified in two patients and managed by primary repair. Two patients in whom the diagnosis and intervention were delayed died within 1 week of surgery. • Metastatic progression was observed in two patients shortly after the perforation (median interval, 4.8 months), and local pelvic recurrence was noted in one of them. • None of the patients with stage Ta tumours had evidence of extravesical progression. Actuarial estimates of disease‐free survival at 1, 3 and 5 years after the perforation were 83%, 71% and 41%, respectively. CONCLUSIONS • A significant bladder perforation during TURBT requiring open surgical repair is more likely to occur in elderly patients with large posterior wall tumours and heavily pretreated bladders. • Despite its potential for considerable morbidity, this adverse event does not seem to substantially increase the risk of extravesical tumour seeding. Prompt diagnosis, immediate intervention and meticulous bladder and bowel inspection during laparotomy are imperative.

Intraoperative ventilation and hemodynamic change due to bladder perforation during transurethral resection of a bladder tumor - A case report -

“…The incidence of bladder perforation is suspected of being higher than reported [4]. However, bladder perforation caused by transurethral resection rarely requires surgical treatment.…”

“…In the present case, the size of the tumor was fairly large (3.8 cm), and the patient was elderly (80 years) and had undergone three prior TURB surgeries. In addition, the tumor was spread over the entire bladder, putting the patient at high risk group for bladder perforation that could require surgical treatment [4].…”

“…However, its complications include hemorrhage, infection, transurethral resection syndrome (TURS), bladder perforation, urinary tract obstruction, urinary incontinence, and sepsis [1,2]. While bladder perforation occurs in up to 58% of all cases, cases of bladder perforation that require surgical treatment are rare [3,4]. Risk for bladder perforation …”

Tumour seeding as a result of intraperitoneal perforation during transurethral resection of non-muscle invasive bladder cancer

“…Golan et al 1 also presented a recent review of 4144 TURBT patients, of which 15 had bladder perforations and two had extravesical recurrence. In a comparative study, patients with bladder cancer with perforation showed a trend towards an increase in recurrence and progression and a decrease in survival 10.…”

“…Perforation can also delay the time to complete resection and prevent immediate intravesical chemotherapy—both of which may increase the likelihood of recurrence, progression and metastasis. There are relatively few clinical reports of extravesical recurrence from seeding 1 4 5 10. We report on a rare case of extravesical recurrence in the left paracolic gutter in a 61-year-old woman who underwent a TURBT for non-muscle invasive urothelial carcinoma complicated by intraperitoneal bladder perforation and open repair.…”