title: Complications associated with primary and secondary perforation of the bladder following immediate instillations of epirubicin after transurethral resection of superficial urothelial tumours.
abstract: BACKGROUND
  Significant decreases in tumour recurrence rates of up to 50% are reported after one immediate postoperative instillation of chemotherapeutic drugs, such as epirubicin or mitomycin C. However, the extremely rare occurrence of complications related to perforation of the bladder can be detrimental. Perforation of the bladder seems to be iatrogenic (primary) or drug-induced (secondary).
  
  
  METHODS
  We present two cases of significant morbidity related to primary and secondary perforation of the bladder following two instillations of epirubicin.
  
  
  RESULTS
  The patient with the primary perforation was managed conservatively, while the second was subjected to immediate surgical exploration. The two patients were finally released in good condition.
  
  
  CONCLUSIONS
  Complications concerning a primary perforation of the bladder and instillation of chemotherapeutic drugs can be easily avoided by recognising the perforation intraoperatively. However, we postulate that a delayed perforation of the bladder might occur due to the cytotoxic effect to the bladder tissue of the instilled drugs.
authors.affiliation: Department of Urology, Athens University Medical School-LAIKO Hospital, 17 Agiou Thoma str, 11527, Athens, Greece. statyr@freemail.gr
authors.forename: S I
authors.initials: SI
authors.lastname: Tyritzis
authors.forename: Konstantinos G
authors.initials: KG
authors.lastname: Stravodimos
authors.forename: A
authors.initials: A
authors.lastname: Mihalakis
authors.forename: Constantinos A
authors.initials: CA
authors.lastname: Constantinides
mesh_terms: D000283:Administration, Intravesical; D000368:Aged; D000369:Aged, 80 and over; D017024:Chemotherapy, Adjuvant; D015653:Cystectomy / Q000379:methods; D003558:Cystoscopy / Q000379:methods; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D015251:Epirubicin / Q000008:administration & dosage* / Q000009:adverse effects; D005500:Follow-Up Studies; D006801:Humans; D007049:Iatrogenic Disease; D008297:Male; D019060:Minimally Invasive Surgical Procedures / Q000379:methods; D018570:Risk Assessment; D012421:Rupture; D016896:Treatment Outcome; D014521:Urethra; D001743:Urinary Bladder / Q000293:injuries*; D001749:Urinary Bladder Neoplasms / Q000188:drug therapy* / Q000473:pathology / Q000601:surgery*; D013521:Urologic Surgical Procedures, Male / Q000379:methods; D014950:Wounds, Penetrating / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy
chemical_list: D015251:Epirubicin