One immediate postoperative instillation of chemotherapy in low risk Ta, T1 bladder cancer patients. Is it always safe?
OBJECTIVE
The optimal treatment for solitary low grade, low stage papillary bladder tumours consists of transurethral resection (TUR) followed by one immediate postoperative instillation with a chemotherapeutic drug. However, when during TUR a bladder perforation or a near-perforation occurs, instillation of a chemotherapeutic drug may lead to leakage outside the bladder, possibly causing severe morbidity. So far, few case reports dealing with complications using mitomycin C have been published, but severe complications of leakage after an early adjuvant instillation with epirubicin have not been reported.


METHODS
We describe 3 patients in whom we observed serious complications of one immediate postoperative instillation of epirubicin.


RESULTS
Two of the patients recovered after conservative therapy, one patient died due to multi organ failure after explorative laparotomy.


CONCLUSIONS
In order to prevent such complications, an immediate postoperative instillation has to be avoided when there is overt or even suspicion of bladder wall perforation.
Oddens
J R
JR
Department of Urology, Jeroen Bosch Hospital, 's Hertogenbosch, The Netherlands. oddens@hotmail.com
van der Meijden
A P M
AP
Sylvester
R
R
D000283:Administration, Intravesical; D000368:Aged; D000369:Aged, 80 and over; D000903:Antibiotics, Antineoplastic / Q000008:administration & dosage*; D002291:Carcinoma, Papillary / Q000188:drug therapy* / Q000473:pathology / Q000601:surgery; D017024:Chemotherapy, Adjuvant; D015653:Cystectomy / Q000379:methods*; D003558:Cystoscopy; D015251:Epirubicin / Q000008:administration & dosage*; D017809:Fatal Outcome; D006801:Humans; D008297:Male; D009367:Neoplasm Staging; D011184:Postoperative Period; D016896:Treatment Outcome; D001749:Urinary Bladder Neoplasms / Q000188:drug therapy* / Q000473:pathology / Q000601:surgery
D000903:Antibiotics, Antineoplastic; D015251:Epirubicin