Incidence Of Bladder Perforation Research Articles

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

ObjectivesTo 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).MethodsThis 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.ResultsOur 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.ConclusionsThe 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.

A Systematic Review and Meta-Analysis Comparing the Safety and Efficacy of Spinal Anesthesia and Spinal Anesthesia Combined with Obturator Nerve Block in Transurethral Resection of Bladder Tumors.

Background Transurethral resection of bladder tumors (TURBT) is the main surgical treatment for bladder cancer, but during TURBT, it is easy to stimulate the obturator nerve passing close to the lateral side of the bladder wall and induce involuntary contraction of the adductor muscle group of the thigh innervated by it, which will affect the surgical process and lead to adverse reactions. Obturator nerve block (ONB) helps to prevent the obturator nerve reflex. This study systematically evaluated and meta-analyzed the reports on the co-application of ONB and spinal anesthesia (SA) in TURBT in recent years to provide evidence for clinical diagnosis and treatment. Methods The clinical randomized controlled literature studies of ONB combined with SA in TURBT published in PubMed, EMBASE, the Cochrane Library, CNKI (China National Knowledge Infrastructure), and Wanfang databases from January 2000 to December 2021 were searched. After screening the qualified literature studies, the literature quality was assessed by the Jadad scale. The incidence of obturator nerve reflex, the incidence of bladder perforation, length of hospital stay, and tumor recurrence rate were used as outcome indicators. The meta-analysis was performed with the R language toolkit. Results A total of 444 articles were initially retrieved, and after the screening, a total of 8 articles were included in the selection, and a total of 635 patients with ureterovesical tumor resection were included. The meta-analysis showed that the use of SA + ONB anesthesia during TURBT was associated with a smaller incidence of bladder perforation (RR = 0.24, 95% CI (0.11, 0.53), Z = −3.48, P=0.0005), a smaller incidence of obturator nerve reflex (RR = 0.22, 95% CI (0.13, 0.36), Z = −6.11, P=0.0001), a significantly shorter length of hospital stay (MD = −1.81, 95% CI (−2.65, −0.97), Z = −4.24, P=0.0001), and a significantly lower tumor recurrence rate (RR = 0.46, 95% CI (0.29, 0.73), Z = −3.30, P=0.001) compared with SA alone. Conclusion The application of SA combined with ONB in TURBT can effectively reduce the incidence of obturator nerve reflex, reduce the incidence of bladder perforation, shorten the hospital stay and reduce the tumor recurrence rate.

Risk Factors for Bladder Perforation at the Time of Retropubic Midurethral Sling Placement.

There is conflicting evidence regarding predictive factors for bladder perforation during retropubic midurethral sling (R-MUS) placement and lack of evidence to support adoption of techniques to minimize such injury. The aims of the study were to describe the incidence of and factors associated with bladder perforation during R-MUS placement and to explore whether retropubic hydrodissection decreases the likelihood of perforation. This is a case-control study of women undergoing R-MUS placement from 2007 to 2017. Cases were identified by review of the operative reports for evidence of bladder perforation. Patients without bladder perforation were defined as controls and were matched to cases in a 3:1 ratio by surgeon, sling type, and surgery date. A total of 1,187 patients underwent R-MUS placement. The incidence of bladder perforation was 8% (n = 92 patients); 276 controls were matched accordingly (N = 368). Patients with bladder perforations were more likely to have a body mass index (BMI) less than 30 (P = 0.004) and to have a diagnosis of endometriosis (P = 0.02). They were also more likely to have had previous hysterectomy (P = 0.03) and urethral bulking (P = 0.01). On logistic regression, bladder perforation remained associated with a BMI less than 30 (adjusted odds ratio, 2.22 [95% confidence interval, 1.30-3.80]) and endometriosis (adjusted odds ratio 2.90 [95% confidence interval, 1.15-7.01]). Retropubic hydrodissection was performed in 62% of the patients and was not associated with a lower risk of perforation (P = 0.86). The incidence of bladder perforation was 8%. The risk of this complication is higher in patients with a BMI less than 30 and/or endometriosis. Retropubic hydrodissection may not decrease the likelihood of this event.

Pediatric bladder augmentation - Panacea or Pandora's box?

Bladder augmentation is a surgery that can increase bladder capacity and compliance. The objective of this study was to provide a longitudinal review of pediatric bladder augmentation at a tertiary Canadian center. A retrospective review was performed on patients who underwent bladder augmentation at a tertiary pediatric hospital between 1986 and 2014. The primary objective was short- and long-term complications of augmentation. Secondary objectives were to review number of augmentation procedures performed over time and the utility of routine postoperative cystograms. A total of 56 procedures were performed on 54 patients (28 males, 26 females) of mean age 10 years (standard deviation [SD] 5) and mean followup eight years (SD 5). The most common bowel segment used was ileum (87.5%). Twenty-eight patients (50%) received catheterizable channels. Overall complication rate was 15% and the most common complications were urinary tract infections (68.5%), worsening hydronephrosis (14.8%), bladder stone formation (14%), and hematuria (13%). In total, 19 of 54 (35.2%) patients returned to the operating room. The incidence of bladder perforation was 3.6%. Complications with the catheterizable channel occurred in 13 of 28 (46.4%), of which 10 were related to stomal stenosis. Forty patients had postoperative cystograms and extravasation was seen in three (7.5%). There was no malignancy during the followup. Only four augmentations were performed from 2008-2014. Bladder augmentation likely represents a safe surgical treatment option. Extravasation on postoperative cystogram was uncommon and, thus, it may not be indicated routinely. The number of augmentation procedures performed has declined in recent years.

Operation mode to prevent obturator nerve reflex in plasmakinetic resection of bladder tumor

Objective To observe the results and reality of transurethral resection of bladder tumor with preexcitation of electric cutting loop in the prevention of obturator nerve reflex. Methods The clinical data of 186 patients with bladder tumors admitted from January 2015 to August 2018 were retrospectively analyzed. There were 112 males and 74 females aged 35 to 83 years, average(59±11)years. 76 patients were admitted because of intermittent gross hematuria and 110 patients were admitted because of physical check-up. All patients underwent ultrasound, CT (plain scan/enhancement) and cystoscopy before operation. The pathological diagnosis of cystoscopy biopsy was bladder urothelial cell carcinoma.There were 105 cases clinical stage Ta stage, 81 cases of T1 stage. There were 103 single cases and 39 multiple cases of non-muscular invasive bladder. According to the different surgical techniques, the patients were divided into two groups: the pre-excitation group and lateral incision group. There were 142 cases in pre-excitation group. In the pre-excitation group, the tumors were removed routinely by the resection ring. When the resection ring was far away from the tumors, the pedal switch was pressed to excite the resection ring. The resection ring was moved to the location of the tumors, and the tumors were cut to the muscular layer. The operation was completed after 2 cm electric cauterization around the wound and hemostasis. In the lateral incision group, the tumors were removed routinely by the electric resection ring. The operation time, incidence of obturator nerve reflex, incidence of bladder perforation, amount of bleeding, retention time of catheter, pathological grading, risk grading, hospitalization time and recurrence rate of tumors at 6 months after operation were compared between the two groups. Results The operation was successfully completed in both groups, and there was no transition to open operation. In the pre-excitation group, the operation time was 10 minutes to 56 minutes, with an average of (28±12) minutes, and the intraoperative blood loss ranged from 5 ml to 70 ml, with an average of (35±15) ml. In the lateral incision group, the operation time was 15 minutes to 65 minutes, with an average of (28±11) minutes, and the blood loss was 10 ml to 80 ml, with an average of (40±15) ml. There was no significant difference in operation time and blood loss between the two groups (P>0.05). There were only 3 cases of obturator nerve reflex in preexcitation group, the incidence was 2.1%. There were 13 cases of obturator nerve reflex in lateral resection group, the incidence was 29.5%. There was significant difference of nerve reflex incidence between the two groups (P<0.05). Conclusions In transurethral resection of bladder tumors, the method of pre-excitation of plasma resection ring can effectively decrease obturator nerve reflex and make the operation safer. Key words: Bladder tumors; Plasmakinetic resection of bladder tumor; Obturator nerve reflex

Bipolar Transurethral Resection of Bladder Tumor Provides Better Tissue for Histopathology But Has No Superior Efficacy and Safety: A Randomized Controlled Trial.

Bipolar transurethral resection of bladder tumors (TURBTs) has been claimed to have lesser complications and better specimen quality, but recent studies have contradictory results, and hence, we conducted this study to compare the clinical efficacy and safety of monopolar and bipolar electrosurgical modalities in TURBTs. A total of 287 patients were enrolled in the study and underwent TURBTs between July 2015 and September 2016. Patients undergoing surgery under general anesthesia and restage procedure were excluded from the study. Patient demographic profile, tumor characteristics, and complications of the procedures such as obturator jerk, bladder perforation, blood loss, need for resurgery, and transurethral resection syndrome were recorded. Tumor specimens were analyzed for stage, grade, deep muscle invasion, and quantity and quality of thermal artifacts. A total of 160 patients were block randomized and analyzed with 80 patients in either group. Patient demographics and tumor characteristics were comparable between the groups. Change in hemoglobin levels and incidence of bladder perforation were comparable between the groups. A higher proportion of patients in bipolar group had obturator jerk compared with those in monopolar group, however, it was not statistically significant (24% vs 14%; p = 0.23). A higher proportion of patients in bipolar group did not have thermal artifacts when compared with monopolar group (27.5% vs 5%; p < 0.0001). The operative risks of bipolar TURBT such as obturator jerk, bladder perforation, and blood loss are comparable with monopolar resection. However, less thermal artifacts in tissue samples obtained with bipolar resection may be helpful to the pathologist in interpretation of histopathologic findings.

AB095. Transurethral holmium laser bladder tumor submucosal dissection (HoL-BTSD) for non-muscle invasive bladder cancer

BackgroundTo compare the clinical efficacy of transurethral holmium laser bladder tumor submucosal dissection (HoL-BTSD) and transurethral bipolar plasma dissection of bladder tumor (TURBT) in the treatment of non-muscle invasive bladder cancer (NMIBC).MethodsFrom September 2012 to April 2016, 105 patients diagnosed with NMIBC were randomly divided into HoL-BTSD and TURBT group. A total 53 cases in HoL-BTSD and 52 cases in TURBT according to the operation method. The operation time, intraoperative bleeding, postoperative urinary catheter indwelling time, hospitalization time, main complication rate and 1 and 2 years recurrence rate were compared between two groups.ResultsBetween HoL-BTSD group and TURBT group, the mean operation time was 27.46±9.45 vs. 24.43±8.51 min (P>0.05). The mean intraoperative blood loss was 12.07±6.14 vs. 20.62±8.20 mL (P<0.05). The incidence of obturator reflex was 0% vs. 33.9% (P<0.05). The incidence of bladder perforation is 1.92% vs. 15.1% (P<0.05). The mean postoperative hospital stay was 6.10±1.62 vs. 7.66±1.79 days (P<0.05). The catheter retention time was 5.12 ±1.69 vs. 6.70±1.67 days (P<0.05). The incidence of postoperative bleeding was 0% vs. 11.3% (P<0.05). The incidence of urethral stricture was 3.85% vs. 7.55% (P>0.05). The rate of 1-year tumor recurrence was 5.8% vs. 18.9%. The rate of 2 years tumor recurrence was 13.5% vs. 35.8%.ConclusionsTransurethral holmium laser dissection of bladder tumor in the treatment of non-muscular infiltration of bladder cancer is effective with less complications, rapid recovery, early discharge, and low postoperative recurrence rate.

Risk factors for spontaneous bladder perforation after augmentation cystoplasty

Objectives To present our experience with the use of stomach, ileum, and colon for augmentation cystoplasty to examine the incidence of, and risk factors for, spontaneous perforation. Spontaneous bladder perforation is a potentially life-threatening complication of augmentation cystoplasty with a reported incidence of up to 13%. Methods A retrospective review of medical records from 1988 to 2001 identified 107 children (57 males and 50 females) who underwent augmentation cystoplasty at our institution. The etiology for bladder dysfunction included myelomeningocele, VATER (vertebral defects, imperforate anus, tracheoesophageal fistula, radial and renal dysplasia) syndrome, bladder and cloacal exstrophy, posterior urethral valves, and pelvic malignancy. Thirteen patients also had end-stage renal disease. Results The median follow-up was 7.4 years. Gastrocystoplasty was performed in 50 children (47%), ileocystoplasty in 37 (35%), colocystoplasty in 18 (17%), and gastric-ileal composite neobladder in 2 (2%). Augmentation cystoplasty procedures were performed using a standard technique that included a two-layer anastomosis. Additional procedures at the time of reconstruction included Mitrofanoff neourethra in 66 patients (62%) and bladder neck repair in 44 (41%). Postoperatively, most patients started a strict incremental catheterization regimen. The overall incidence of bladder perforation was 5%, with one traumatic (1%) and four spontaneous (4%) perforations. All patients recovered uneventfully after exploratory laparotomy. Conclusions We believe that the relatively low incidence of spontaneous bladder perforation encountered in this series may be explained by the large number of patients with gastrocystoplasty, as well as our strict adherence to a postoperative incremental catheterization program.

A nationwide analysis of complications associated with the tension-free vaginal tape (TVT) procedure

Background. To evaluate the therapy-associated morbidity of all patients who underwent a TVT operation in Finland by the end of the year 1999. Methods. Questionnaires on the number of operations and on the number of different complications were sent to 38 hospitals where TVT operations had been independently performed after an obligatory TVT training period. The primary TVT training center and a hospital, which did not use the standard TVT equipment, were excluded. Results. Among the 38 hospitals there were four university, 13 central and 21 local hospitals. The total number of operations was 1455. The incidence of bladder perforation was 38/1000, that of intra-operative blood loss over 200 ml 19/1000, of major vessel injury 0.7/1000, of nerve injury 0.7/1000, of vaginal hematoma 0.7/1000 and of urethral lesion 0.7/1000. The incidence of minor voiding difficulty was 76/1000, that of urinary tract infection 41/1000, of complete postoperative urinary retention 23/1000, of retropubic hematoma 19/1000, of wound infection 8/1000 and of vaginal defect healing 7/1000. No case of tape rejection or life threatening complication occurred and the incidence of complications requiring laparotomy was 3.4/1000. The ratio of number of complications to TVT operations performed did not vary significantly between different hospital types (p>0.05). Conclusion. The TVT procedure is a safe method for the treatment of stress urinary incontinence provided that appropriate training is offered.

A nationwide analysis of complications associated with the tension-free vaginal tape (TVT) procedure.

To evaluate the therapy-associated morbidity of all patients who underwent a TVT operation in Finland by the end of the year 1999. Questionnaires on the number of operations and on the number of different complications were sent to 38 hospitals where TVT operations had been independently performed after an obligatory TVT training period. The primary TVT training center and a hospital, which did not use the standard TVT equipment, were excluded. Among the 38 hospitals there were four university, 13 central and 21 local hospitals. The total number of operations was 1455. The incidence of bladder perforation was 38/1000, that of intra-operative blood loss over 200 ml 19/1000, of major vessel injury 0.7/1000, of nerve injury 0.7/1000, of vaginal hematoma 0.7/1000 and of urethral lesion 0.7/1000. The incidence of minor voiding difficulty was 76/1000, that of urinary tract infection 41/1000, of complete postoperative urinary retention 23/1000, of retropubic hematoma 19/1000, of wound infection 8/1000 and of vaginal defect healing 7/1000. No case of tape rejection or life threatening complication occurred and the incidence of complications requiring laparotomy was 3.4/1000. The ratio of number of complications to TVT operations performed did not vary significantly between different hospital types (p>0.05). The TVT procedure is a safe method for the treatment of stress urinary incontinence provided that appropriate training is offered.