ESOU18: Complications of TURBT

Amsterdam, The Netherlands ( Transurethral resection of bladder tumor (TURBT) followed by pathologic examination of the obtained specimen, is an essential step in the treatment of non-muscle invasive bladder cancer (NMIBC). It is imperative that the resection be complete, include the muscle layer, and if needed, a second look resection should be performed.

Large series have shown a complication rate of 8% in TURBT surgeries with 85% being Clavien grade 1-2. It has been shown residents performing the procedure, attain the same complication rate as non-residents, as long as they are under direct supervision by their attending physician. However, residents were less likely to obtain muscle tissue in their resection. 

Bladder perforation is a known TURBT complication. Associated risk factors include previous resection, elderly patients, lateral bladder wall tumors (causing obturator stimulation), and presence of bladder diverticula. Factors that help prevent these complications include surgeon experience, empty bladder and curarization or obturator nerve block. Management of bladder perforation is dependent on whether the perforation is extraperitoneal (conservative) or intraperitoneal (surgical repair of the perforation). In any case, when a perforation has occurred, it is important to  avoid any immediate intravesical instillation.

Dr. Masson-Lecomte continued to discuss on when to stop resecting a large tumor. It is known that the rate of complications increases as the operative duration increases. The maximal time for the procedure is approximately 90 minutes. When the tumor is covering the ureteral orifice,  it is feared that resection of it could  have functional and oncological impact and cause ureteral scarring and stenosis, or tumor recurrence. Therefore, it is important to follow-up with upper tract ultrasound. A possible method to avoid ureteral stenosis is to perform endoscopic spatulation of the intramural ureter.

Another rare possible complication is significant postoperative bleeding, with a proposed incidence of 1% of all TURBT cases. Single postoperative chemotherapy instillation after TURBT, has shown to reduce recurrence in 35 % of cases at 1 year follow-up.

In summary, TURBT complications are rare but can be managed, and more importantly prevented, in simple practical steps.

Speaker: Alexandra Masson-Lecomte, Hôpitaux Universitaires Henri Mondor, France

Written By: Hanan Goldberg, MD, Urologic Oncology Fellow (SUO), University of Toronto, Princess Margaret Cancer Centre @GoldbergHanan at The 15th Meeting of the EAU Section of Oncological Urology ESOU18 - January 26-28, 2018 - Amsterdam, The Netherlands