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文 献 解 读. 辽宁省肿瘤医院泌尿外科 李刚. Preface. Bleeding （ 2.3% to 4.6% ） Perforation （ 0.9% to 5% ）. C omplication of TURBT. Extraperitoneal (67% to 88%) Intraperitoneal. Classification. Preface. Leakage Infection bowel injury cancer cell dissemination.

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文 献 解 读

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  1. 文 献 解 读 辽宁省肿瘤医院泌尿外科 李刚

  2. Preface Bleeding（2.3% to 4.6%） Perforation（0.9% to 5%） Complication of TURBT Extraperitoneal (67% to88%) Intraperitoneal Classification

  3. Preface • Leakage • Infection • bowel injury • cancer cell dissemination. • systemic absorption of irrigation fluid • complications of immediate intravesical • chemotherapy Complications of perforation

  4. tumor stage(pT0, pTis, pTa, pT1 and pT2) • infiltration depth (superficial vs muscle infiltrative) • number of resected tumors (1, 2 or greater than 2) • resection weight (less than 2.5, 2.5 to less than 5.0, • 5.0 to less than 10, 10.0 to less • than 20.0 and 20.0 gm orgreater). • Gender • BMI (less than 25, 25 to 30 and greater than • 30kg/m2) • nicotine use (active smoker, nonsmoker and • former smoker) Tumor characteristics Patient characteristics MATERIALS AND METHODS 1,284 patients,January 1986 to December 2006

  5. Inadvertent bladder perforation was recognized in 49 patients (3.8%). • Intraperitoneal (5 of 49 , 10.2%) • Extraperitoneal(44of 49 , 89.8%) Result

  6. Result • Bladder perforation occurred 3 times more often in female than in male patients(7.2%vs2.6%,p<0.001). • lower BMI(less than 25 kg/m2) bladder perforation occurred more often than in those with a normal BMI(25 to 30 kg/m2) and in obese patients(BMIgreater than 25 kg/m2)

  7. Result • Patients with muscle invasive tumors showed a two fold higher rate of bladder perforation than patients with non muscleinfiltrative tumors. • A higher resection weight was associated with • a higher bladder perforation rate. • Tumor grade and the number of resected tumors • had no influence on the rate of bladder perforation

  8. Result

  9. inability to distend the bladder • abdominal distention and tachycardia • visualization of fat • a dark space between muscle fibers • visible small bowel Signs of perforation DISCUSSION

  10. DISCUSSION • Tumor size and a tumor site at the bladder dome were risk factors for bladder perforation. • During follow up there was no hint for tumor seeding. Balbay, et al, J Urol 2005; 174: 2260 El Hayek, et al,J Endourol 2009; 23:1183

  11. DISCUSSION Extraperitoneal—adequate bladder drainage via a urethral catheter Treatment of perforation Intraperitoneal—1.open or laparoscopic surgical repair 2.percutaneous drainage of the abdomen Chakravarti A,et al, BJU Int, 2000;85:1150.

  12. surgical repair of bladder perforation during TURBT • increases the risk of extravesical tumor cell spread. Andreas et al,J of Urol,2005,173,1908.

  13. conclusion • multiple logistic regression onlygender andBMI were identified as risk factors for bladder perforation.

  14. Summary • Minimizing bladder irrigation • Layer resection • avoid the obturator nerve reflex method of prevent bladder perforation

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