Evaluation of the incidence of bladder perforation after transurethral bladder tumor resection in a residency setting.
OBJECTIVE
To evaluate prospectively the actual bladder perforation incidence during transurethral resection of bladder tumor (TURB) performed by residents and to identify possible predisposing factors to such condition.


METHODS
Thirty-four patients with bladder tumor were submitted to TURB in our academic institution in April 2006, and were prospectively studied. Procedures were all done by senior residents under an attending direct supervision. All patients had a cystograms performed after the procedure by the injection of 400 mL of saline-diluted contrast solution with low-pressure infusion through the Foley catheter. The cystograms were evaluated blindly by a single radiologist. All patients were examined by cystoscopy and/or CT every 3 months for the first 2 years postoperatively.


RESULTS
The cystogram showed contrast leaking compatible with bladder perforation in 17 (50%) cases. None of the perforations were recognized intraoperatively by the surgeon. All perforations were extraperitoneal and managed conservatively. There was no significant correlation between the incidence of bladder perforation and the patient age (p = 0.508), the tumor stage (p = 0.998), the tumor grade (p = 0.833), the number of lesions (p = 0.394), and the tumor size (p = 0.651). The only factor that had impact on the development of bladder perforation was tumor localization at the bottom of the bladder (p = 0.035; OR, 6750; 95% CI, 1.14, 39.8).


CONCLUSIONS
Asymptomatic perforations of the bladder wall occur very frequently after a TURB procedure performed by residents in training and, most of the time, are not noticed by the surgeon. Localization of the tumor at bladder dome was the only factor that negatively influenced perforation rates.
El Hayek
Omar R
OR
Divisão de Clínica Urológica, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil.
Coelho
Rafael Ferreira
RF
Dall'oglio
Marcos Francisco
MF
Murta
Cláudio Bovolenta
CB
Ribeiro Filho
Leopoldo Alves
LA
Nunes
Ricardo Luís Vita
RL
Chade
Daher
D
Menezes
Marcos
M
Srougi
Miguel
M
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D015994:Incidence; D007396:Internship and Residency; D008297:Male; D008875:Middle Aged; D014521:Urethra / Q000601:surgery*; D001745:Urinary Bladder Diseases / Q000453:epidemiology* / Q000209:etiology*; D001749:Urinary Bladder Neoplasms / Q000601:surgery*; D013520:Urologic Surgical Procedures / Q000009:adverse effects*