title: Evaluation of the incidence of bladder perforation after transurethral bladder tumor resection in a residency setting.
abstract: 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.
authors.affiliation: Divisão de Clínica Urológica, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil.
authors.forename: Omar R
authors.initials: OR
authors.lastname: El Hayek
authors.forename: Rafael Ferreira
authors.initials: RF
authors.lastname: Coelho
authors.forename: Marcos Francisco
authors.initials: MF
authors.lastname: Dall'oglio
authors.forename: Cláudio Bovolenta
authors.initials: CB
authors.lastname: Murta
authors.forename: Leopoldo Alves
authors.initials: LA
authors.lastname: Ribeiro Filho
authors.forename: Ricardo Luís Vita
authors.initials: RL
authors.lastname: Nunes
authors.forename: Daher
authors.initials: D
authors.lastname: Chade
authors.forename: Marcos
authors.initials: M
authors.lastname: Menezes
authors.forename: Miguel
authors.initials: M
authors.lastname: Srougi
mesh_terms: 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*