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. 2023 Sep;55(9):2161-2167.
doi: 10.1007/s11255-023-03638-6. Epub 2023 Jun 15.

Bladder perforation as a complication of transurethral resection of bladder tumors: the predictors, management, and its impact in a series of 1570 at a tertiary urology institute

Yasser Osman  1 , Mohamed Elawdy  2   3 , Diaa-Eldin Taha  1   4 , Mohamed H Zahran  1 , Rasha T Abouelkheir  5 , Doaa Elsayed Sharaf  5 , Ahmed Mosbah  1 , Bedeir Ali-El Dein  1
Affiliations

Bladder perforation as a complication of transurethral resection of bladder tumors: the predictors, management, and its impact in a series of 1570 at a tertiary urology institute

Yasser Osman et al. Int Urol Nephrol. 2023 Sep.

Abstract

Objectives: To report the incidence, predictors, the impact of bladder perforation (BP), and our protocol of management in patients who underwent trans-urethral resection of bladder tumor (TURBT).

Methods: This is a retrospective study, between 2006 and 2020, on patients who underwent TURBT for non-muscle-invasive bladder cancer (NMIBC). Bladder perforation was defined as any full thickness resection of the bladder wall. Bladder perforations were managed based on their severity and type. Small BP with no or mild symptoms were managed with prolongation of urethral catheters. Those with significant extraperitoneal extravasations were managed by insertion of a tube drain (TD). Abdominal exploration was done for extensive BP and all intraperitoneal extravasations.

Results: Our study included 1,570 patients, the mean age was 58 ± 11 years and 86% were males. Bladder perforation was recorded in 10% (n = 158) of the patients. The perforation was extraperitoneal in 95%, and in 86%, the perforation was associated with no symptoms, mild symptoms, or mild fluid extravasation that required only prolongation of the urethral catheter. On the other hand, active intervention was required for the 21 remaining patients (14%) with TD being the most frequent management. History of previous TURBT (p = 0.001) and obturator jerk (p = 0.0001) were the only predictors for BP.

Conclusions: The overall incidence of bladder perforation is 10%; however, 86% required only prolongation of urethral catheter. Bladder perforation did not affect the probability for tumor recurrence, tumor progression nor radical cystectomy.

Keywords: Bladder perforation; Bladder tumor; Management; TURB; TURBT; Transurethral resection of bladder tumors.

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Conflict of interest statement

The authors declare that they have no conflict of interests.

Figures

Fig. 1
Fig. 1
65-year-old male who came to the ER with an acute abdomen 5 days post TURBT and after 2 days of removal of the urethral catheter. CT cystogram axial view showing extravasation of the contrast outside the UB in the extraperitoneal space
Fig. 2
Fig. 2
In the same patient, CT cystogram axial view with post indwelling urethral catheter for 10 days after the initial presentation showing the contrast in the UB with resolving of the extravasation
See this image and copyright information in PMC

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