title: The actual incidence of bladder perforation following transurethral bladder surgery.
abstract: OBJECTIVE
  In this prospective study we evaluated the incidence of bladder perforation after transurethral bladder tumor resection.
  
  
  METHODS
  A total of 36 patients (33 male, 3 female, mean age +/- SD 65.6 +/- 11.43 [range 26 to 81]) with a solid mass in the bladder (mean 20.3 +/- 8.7 mm, range 5 to 40) were included in the study. Transurethral resections were performed with a 24Fr resectoscope. After the procedure an 18Fr Foley catheter was inserted into the bladder and 400 ml of 1/4 saline diluted contrast solution was instilled under gravity from 60 cm above the bladder. Complete filling and post-drainage radiographs were taken and examined for any evidence of extravasation. Regular evaluations with cystoscopy and ultrasound/computerized tomography were done to detect possible tumor recurrence and perivesical seeding.
  
  
  RESULTS
  Histopathological examination of the tumors showed transitional cell carcinoma in 35 patients and chronic eosinophilic cystitis in 1. Review of the cystograms revealed various degrees of extraperitoneal contrast extravasation around the resected area in 21 patients (58.3%). The only statistically significant difference between patients with and without extravasation was in tumor size (logistic stepwise regression p = 0.030,) among factors tested including patient age and localization, number of foci, tumor grade and stage. No apparent clinical problems requiring medical or surgical intervention other than urethral catheterization developed and no evidence of extravesical tumor seeding as per ultrasound and/or computerized tomography was seen during a mean followup of 21.9 months (range 7 to 40).
  
  
  CONCLUSIONS
  The extravasation of urine (asymptomatic perforation) after transurethral bladder tumor resection may occur much more frequently than believed or reported. It seems that this extravasation does not impose a significant risk of extravesical tumor seeding.
authors.affiliation: Atatürk Training and Research Hospital, 1st Urology Clinic and Department of Urology, Fatih University School of Medicine, Ankara, Turkey. mderyabalbay@yahoo.com
authors.forename: M Derya
authors.initials: MD
authors.lastname: Balbay
authors.forename: Ersin
authors.initials: E
authors.lastname: Cimentepe
authors.forename: Ali
authors.initials: A
authors.lastname: Unsal
authors.forename: Omer
authors.initials: O
authors.lastname: Bayrak
authors.forename: Akif
authors.initials: A
authors.lastname: Koç
authors.forename: Ziya
authors.initials: Z
authors.lastname: Akbulut
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002295:Carcinoma, Transitional Cell / Q000601:surgery; D015653:Cystectomy / Q000009:adverse effects* / Q000379:methods; D018856:Cystitis, Interstitial / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009367:Neoplasm Staging; D011183:Postoperative Complications / Q000175:diagnosis / Q000453:epidemiology* / Q000209:etiology*; D011446:Prospective Studies; D012421:Rupture / Q000209:etiology; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D014521:Urethra / Q000601:surgery*; D001743:Urinary Bladder / Q000293:injuries*; D001749:Urinary Bladder Neoplasms / Q000175:diagnosis / Q000601:surgery*