Abstract
Introduction
Significant decreases in tumour recurrence rates of up to 50% are reported after one immediate postoperative instillation of chemotherapeutic drugs, such as epirubicin or mitomycin C. However, the extremely rare occurrence of complications related to perforation of the bladder can be detrimental. Perforation of the bladder seems to be iatrogenic (primary) or drug-induced (secondary).
Materials and methods
We present two cases of significant morbidity related to primary and secondary perforation of the bladder following two instillations of epirubicin.
Results
The patient with the primary perforation was managed conservatively, while the second was subjected to immediate surgical exploration. The two patients were finally released in good condition.
Conclusions
Complications concerning a primary perforation of the bladder and instillation of chemotherapeutic drugs can be easily avoided by recognising the perforation intraoperatively. However, we postulate that a delayed perforation of the bladder might occur due to the cytotoxic effect to the bladder tissue of the instilled drugs.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Oosterlinck W, Kurth KH, Schröder F, Bultinck J, Hammond B, Sylvester R (1993) A prospective European Organization for Research and Treatment of Cancer Genitourinary Group randomized trial comparing transurethral resection followed by a single intravesical instillation of epirubicin or water in single stage Ta, T1 papillary carcinoma of the bladder. J Urol 149:749–752
Rajala P, Kaasinen E, Raitanen M, Liukkonen T, Rintala E (2002) Perioperative single dose instillation of epirubicin or interferon-alpha after transurethral resection for the prophylaxis of primary superficial bladder cancer recurrence: a prospective randomized multicenter study–Finnbladder III long-term results. J Urol 168:981–985. doi:10.1016/S0022-5347(05)64556-9 Finnbladder Group
Sylvester RJ, Oosterlinck W, van der Meijden AP (2004) Single immediate postoperative instillation of chemotherapy decreases the risk of recurrence in patients with stage Ta T1 bladder cancer: a meta-analysis of published results of randomized clinical trials. J Urol 171:2186–2190. doi:10.1097/01.ju.0000125486.92260.b2
Oddens JR, van der Meijden AP, Sylvester R (2004) One immediate postoperative instillation of chemotherapy in low risk Ta, T1 bladder cancer patients. Is it always safe? Eur Urol 46:336–338. doi:10.1016/j.eururo.2004.05.003
Doherty AP, Trendell-Smith N, Stirling R, Rogers H, Bellringer J (1999) Perivesical fat necrosis after adjuvant intravesical chemotherapy. BJU Int 83:420–423. doi:10.1046/j.1464-410x.1999.00951.x
Cliff AM, Romaniuk CS, Parr NJ (2000) Perivesical inflammation after early mitomycin C instillation. BJU Int 85:556–557. doi:10.1046/j.1464-410x.2000.00539.x
Ohguchi N, Sakaida N, Okamura A, Kawakita S, Kawamura H, Matsuda T (1997) Extravesical tumor implantation caused by perforation during transurethral resection of a bladder tumor: a case report. Int J Urol 4:516–518. doi:10.1111/j.1442-2042.1997.tb00296.x
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Tyritzis, S.I., Stravodimos, K.G., Mihalakis, A. et al. Complications associated with primary and secondary perforation of the bladder following immediate instillations of epirubicin after transurethral resection of superficial urothelial tumours. Int Urol Nephrol 41, 865–868 (2009). https://doi.org/10.1007/s11255-009-9536-y
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11255-009-9536-y