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Minerva Urology and Nephrology 2021 Jul 15

DOI: 10.23736/S2724-6051.21.04436-0

Copyright © 2021 EDIZIONI MINERVA MEDICA

language: English

Bladder perforation during transurethral resection of the bladder: a comprehensive algorithm for diagnosis, management and follow up

Chiara LONATI 1, 2 , Francesco ESPERTO 3, Roberto M. SCARPA 3, Rocco PAPALIA 3, Juan GÓMEZ RIVAS 4, Mario ALVAREZ-MAESTRO 4, Luca AFFERI 2, Christian D. FANKHAUSER 2, Agostino MATTEI 2, Renzo COLOMBO 5, Francesco MONTORSI 5, Alberto BRIGANTI 5, Wojciech KRAJEWSKI 6, Roberto CARANDO 2, 7, 8, 9, Ekaterina LAUKHTINA 10, 11, Jeremy Y. TEOH 12, Stefania ZAMBONI 1, Claudio SIMEONE 1, Marco MOSCHINI 2, 5, on behalf of the European Association of Urology - Young Academic Urologists (EAU-YAU): Urothelial Carcinoma Working Group; European Association of Urology - European Society of Resident Urologists (EAU-ESRU)

1 Department of Urology, Spedali Civili of Brescia, Brescia, Italy; 2 Department of Urology, Luzerner Kantonsspital, Lucerne, Switzerland; 3 Department of Urology, Campus Bio-Medico, University of Rome, Rome, Italy; 4 Department of Urology, La Paz University Hospital, Madrid, Spain; 5 Department of Urology, IRCCS San Raffaele Hospital and Vita-Salute San Raffaele University, Milan, Italy; 6 Department of Urology and Oncological Urology, Wrocław Medical University, Wrocław, Poland; 7 Clinica Luganese Moncucco, Lugano, Switzerland; 8 Clinica S.Anna, Swiss Medical Group, Sorengo, Switzerland; 9 Clinica Santa Chiara, Locarno, Switzerland; 10 Department of Urology, Comprehensive Cancer Center, Vienna General Hospital, Medical University of Vienna, Vienna, Austria; 11 Institute for Urology and Reproductive Health, Sechenov University, Moscow, Russia; 12 Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China


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INTRODUCTION: Despite bladder perforation (BP) is a frequent complication during transurethral resection of bladder (TURB) for bladder cancer (BCa), literature lacks systematic reviews focusing on this issue. We aimed to investigate incidence, diagnosis, therapy, and prognosis after BP during TURB for BCa; therapy was distinguished between conservative (without the need for bladder repair) and surgical management (requiring bladder wall closure).
EVIDENCE ACQUISITION: A systematic search was conducted up to April 2021 using PubMed, Scopus, Cochrane Database of Systematic Reviews, and Web of Science to identify articles focusing on incidence, detection, management, or survival outcomes after iatrogenic BP. The selection of articles followed the Preferred Reporting Items for Systematic Review and Meta-Analyses process.
EVIDENCE SYNTHESIS:We included 41 studies, involving 21,174 patients. Overall, 521 patients experienced BP during TURB for BCa, with a mean incidence of 2.4%, up to 58.3% when post-operative cystography is routinely performed after all TURB procedures. Risk factors were low body mass index (BMI) (p=0.01), resection depth (p=0.006 and p=0.03), and low surgical experience (p=0.006). Extraperitoneal BP (68.5%) were treated conservatively in 97.5% of patients; intraperitoneal BP were managed with surgical bladder closure in 56% of cases. Overall, three immediate BP-related deaths were recorded due to septic complications. Extravesical tumour seeding was observed after 6 intraperitoneal and 1 extraperitoneal BP (median time: 6.2 months). Intraperitoneal BP (p=0.0003) and bladder closure (p<0.001) were found as independent predictors of extravesical tumour recurrence.
CONCLUSIONS: BP is more frequent than expected when proper diagnosis is routinely performed after all TURB procedures. Risk factors include low BMI, resection depth, and unexperienced surgeon. The risk of sepsis after BP suggests empirical antibiotic prophylaxis after BP.


KEY WORDS: Bladder perforation; Iatrogenic perforation; Transurethral resection of the bladder; Bladder cancer

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