Factors Influencing Bladder Perforation during Transurethral Resection of Bladder Cancer: A Comprehensive Analysis

• Published in: Archivos españoles de urología Vol. 77; no. 5; p. 471
• Main Authors: Yorulmaz, Enis Mert, Kose, Osman, Ozcan, Serkan, Gorgel, Sacit Nuri, Akin, Yigit
• Format: Journal Article
• Language: English
• Published: Spain 01.06.2024
• Subjects: Aged; Aged, 80 and over; Cystectomy - adverse effects; Female; Humans; Intraoperative Complications - epidemiology; Intraoperative Complications - etiology; Male; Middle Aged; Retrospective Studies; Risk Factors; Transurethral Resection of Bladder; Urethra - injuries; Urinary Bladder - injuries; Urinary Bladder Neoplasms - surgery; variant histology; obturator reflex; TURBT; bipolar energy; bladder perforation
• ISSN: 0004-0614
• DOI: 10.56434/j.arch.esp.urol.20247705.66

Bladder perforation (BP) is one of the important complications during transurethral resection of bladder tumour (TURBT). Additionally, multiple factors can contribute to BP. Here, we investigated the rates of BP, specifically in variant histology of bladder cancer (BC), and examined the clinical follow-up of relevant patients. Of the 797 patients who underwent TURBT between 2015 and 2023, they were divided into two groups according to BP during the operation. Group 1 (n = 744) consisted of patients without BP, whereas Group 2 (n = 53) consisted of patients with BP. Demographic, operative, postoperative and follow-up data were investigated and analysed. Groups were examined in terms of causes of BP. Significance was set at < 0.05. A significantly higher rate of BP was found in patients operated with bipolar energy ( = 0.027) than in their counterparts. In multivariable analysis, the presence of the obturator reflex during TURBT was significantly associated with an increased risk of BP ( < 0.001). We observed a statistically significant increase in the rate of BP in patients with a history of previous intravesical Bacillus Calmette-Guérin (BCG) therapy ( = 0.023). Variant histology was reported in 32 patients (4%). However, we could not find any statistically significant relationship between the development of BP and the variant histology of BC ( = 0.641). Multiple factors can affect BP during TURBT. Understanding the factors associated with BP is crucial for improving patient safety and outcomes. According to the results of the present study, the energy source, the presence of obturator reflex during TURBT and intravesical BCG therapy may increase BP. Nevertheless, the presence of variant histology was not significantly associated with BP.