title: Perforation during TUR of bladder tumours influences the natural history of superficial bladder cancer.
abstract: OBJECTIVE
  Bladder perforation is the second most common complication during transurethral resection of bladder tumours. It is unknown whether perforation affects the natural history of the tumour through cell seeding. The aim of this study was to study the impact of perforation on the oncologic outcomes of bladder carcinoma.
  
  
  METHODS
  Between 2003 and 2007, 926 consecutive patients underwent transurethral resection of bladder tumours at our institution; 327 cases were staged ≥ pT2 and were treated immediately with cystectomy and/or multimodal therapy and therefore excluded from the study. An additional 34 cases without urothelial carcinoma were excluded. Of the remaining 565 patients with non-muscle invasive bladder cancer, 457 (80.8 %) were male and 108 (19.2 %) were female with a mean age of 69.5 years in men and 67.3 years in women. Thirty-seven patients (6.5 %) experienced bladder perforation at the time of tumour resection. This group of patients (Group 1) was compared to the remaining 528 patients (Group 2) who did not experience a bladder perforation.
  
  
  RESULTS
  Patients with bladder wall perforation experienced a shorter disease-free survival in both univariate (p = 0.003) and multivariate analyses (p = 0.006). In addition, subsequent recurrences revealed stage progression of recurrent disease (p = 0.05) and trended to a higher number of cystectomies in the perforated group of patients (p = 0.06). Nevertheless, perforation did not appear to influence overall survival (p = 0.127) or cancer-specific survival (p = 0.141).
  
  
  CONCLUSIONS
  The results indicate that bladder perforation during resection of superficial bladder tumours is burdened by a shortened disease-free survival and T-stage progression.
authors.affiliation: Department of Urology, Central Hospital of Bolzano, Lorenz Böhler Street 5, 39100, Bolzano, Italy, complojevi94@yahoo.de.
authors.forename: Evi
authors.initials: E
authors.lastname: Comploj
authors.forename: Christopher B
authors.initials: CB
authors.lastname: Dechet
authors.forename: Michael
authors.initials: M
authors.lastname: Mian
authors.forename: Emanuela
authors.initials: E
authors.lastname: Trenti
authors.forename: Salvatore
authors.initials: S
authors.lastname: Palermo
authors.forename: Michele
authors.initials: M
authors.lastname: Lodde
authors.forename: Christine
authors.initials: C
authors.lastname: Mian
authors.forename: Andrea
authors.initials: A
authors.lastname: Ambrosini-Spaltro
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Horninger
authors.forename: Armin
authors.initials: A
authors.lastname: Pycha
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002295:Carcinoma, Transitional Cell / Q000556:secondary* / Q000601:surgery*; D015653:Cystectomy / Q000379:methods*; D005260:Female; D006801:Humans; D007431:Intraoperative Complications / Q000209:etiology*; D008297:Male; D008875:Middle Aged; D009366:Neoplasm Seeding; D012189:Retrospective Studies; D014521:Urethra; D001743:Urinary Bladder / Q000293:injuries*; D001749:Urinary Bladder Neoplasms / Q000473:pathology* / Q000601:surgery*