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Following transurethral resection of the opening of a large bladder diverticulum a 62-year-old man was in complete urinary retention. The reason was the considerable vent created by altering the hydrodynamics. The complication was resolved only after conventional vesical diverticulectomy. A warning is issued against the use of transurethral treatment of large bladder diverticula.
Nineteen patients, transurethrally resected for low-grade malignant tumours of the urinary bladder at or near the ureteric orifice, were investigated with respect to the presence of distal ureteric stenosis and/or vesico-ureteric reflux. The follow-up studies were performed from 6 to 28 (mean 12) months after the resection and included intravenous pyelography, voiding cystography, cytoscopy with catheterization of the ureteric orifice on the operated side, quantitative urinary culture, and serum creatinine determination. The intravenous pyelographies showed that the ureters on the operated side were significantly wider than those on the control side. This widening was recorded regardless of whether vesico-ureteric reflux was present or not. Vesico-ureteric refluxwas found on the operated side in 9 patients. No reflux was found on the control side in any patient. Preoperatively, no difference in ureteric width was observed between the tumour side and the control side. No severe stenosis was found at the follow-up investigation-in all cases at least a 5 French catheter could be inserted. Postoperatively, the urinary cultures were positive in 4 patients, 3 of whom had a vesico-ureteric reflux. A slight increase in the serum creatinine was noticed in one patient. The absence of ureteric stenosis in this series might be caused by the fact that the resection was performed with a minimum of coagulation.
Transurethral resection has become the operation of choice in almost all cases of benign prostatic enlargement. However, when the gland does not exceed 30 gm. bladder neck incision is easier to perform, results in a lower morbidity, and is less likely to be followed by incontinence and retrograde ejaculation. We studied 2 groups of men with proved obstruction. Complete urodynamic investigation was done on 51 patients before and on 44 patients after the operation. We compared our subjective and objective findings in the 2 groups. The conclusion suggest that bladder neck incision is as effective as transurethral resection in relieving the obstruction of prostatic enlargement in the presence of a small gland.
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Transurethral resection (TUR) is now widely used in combined treatment of urinary bladder cancer, but the procedure may be compromised if applied without evaluation of infiltration and malignancy degree and metastases responsible for frequent recurrences. The aim of this study was design of effective measures to prevent TUR complications. For 8 years the surgeons from the Moscow Medical Academy urological clinic made 824 TURs for bladder tumors in 322 patients (mean age 57.5 years, 72.6% of males, 27.4% of females). At the stage T3-4 TUR was conducted in contraindications to cystectomy or absence of distant metastases. The following intra- or postoperative complications were observed: hemorrhages (4.6%), intraperitoneal perforations (0.3%), extraperitoneal perforations (0.9%), vesicoureteral reflux (2.8%), enuresis (1.2%). The emergence and severity of the complications were dependent on the bladder tumor stage and degree of infiltration of the muscular layer. Positive TUR results are more feasible in more strict approach to the indications for surgery, adequate surgical skills and technique, high-quality anesthesia, early arrest of hemorrhage, low pressure of the washing liquid in the course of operation.
We performed intravesical instillation of epirubicin in 53 patients with the aim of preventing recurrence of bladder tumors. The patients had undergone transurethral resection of superficial bladder tumors (only transitional-cell carcinoma) within the preceding week, between January of 1990 and July of 1991. Recurrence was found in 11.3% (6/53) of cases during follow-up periods lasting from 1 to 20 months. Side effects occurred in 5.7% (3/53) of the patients. The cumulative nonrecurrence rate was 96.0% for a follow-up period of 6 months and 78.4% for 12 months. The results of this study suggest that intravesical instillation of epirubicin is very useful as adjuvant therapy after transurethral resection of superficial bladder tumors.
Transurethral resection (TUR) in combination with endocrine therapy was performed on 30 patients who were on initial treatment for carcinoma of the prostate and 6 patients who had previously been treated for this disease, 5 of whom were suffering from relapse after a satisfactory response to endocrine therapy. This paper reports the results viewed from potential promoting of metastasis and improvement in bladder outlet obstruction. Prior to TUR, urinary retention was present in 11 of initially treated patients (36.7%) and in three of the previously treated patients (50.0%). The average duration of postoperative indwelling catheter was 3.9 +/- 1.6 days in the initially treated group and 5.2 +/- 3.1 days in the previously treated group. Among the initially treated group, two patients with poorly differentiated adenocarcinoma advancing from Stage C to Stage D (15.4%) developed postoperative metastases which demonstrated at 14 and 42 months; the timing of their occurrence, however, was thought to preclude relating the metastases to TUR. Although metastasis occurred early in two patients among the previously treated group (33.3%), it was considered a natural disease course in relapse cases. Obstructive voiding symptoms recurred postoperatively in three patients of the initially treated group (10.0%) and three patients of the previously treated group (50.0%) during 6 months or more of follow-up periods. UR performed for carcinoma of the prostate proved to be fully safe and effective in the initially treated patients, while admitting that a considerable number of relapses seen in the previously treated patients degraded its benefit to some extent. We conclude that TUR contributed to the better quality of life in both initially and previously treated groups of patients with carcinoma of the prostate.
BACKGROUND AND PURPOSE: Bipolar electrocautery has recently been introduced as a modality for transurethral resection of bladder tumors (TURBT). The primary benefits of bipolar TURBT stem from the use of saline irrigant rather than glycine or water. TURBT should be conducted in a fashion such that the resected tissue can be used for proper grading and staging, so excessive cauterization of the tissue should be avoided. In this study, we compared the pathologic characteristics of bladder tumor specimens resected with bipolar versus standard monopolar energy to determine specimen quality. PATIENTS AND METHODS: Bipolar TURBT (Gyrus Medical Inc., Maple Grove, MN) was performed in 11 patients. Pathologic specimens were compared with the specimens from 11 patients who had previously undergone standard monopolar TURBT. Resected tissue was examined by a pathologist who recorded tumor size, grade, location, presence of muscularis propria, presence of muscle invasion, and final diagnosis. The pathologist also determined the degree of cautery artifact in each specimen. The pathologist was blinded to the form of electrocautery used and the clinical diagnosis. RESULTS: Transurethral resection with bipolar electrocautery was carried out without difficulty or complication in all cases. Similarly, there were no complications in resection by standard monopolar electrocautery. The bladder tumor chips obtained with bipolar TURBT were smaller because of the smaller size of the bipolar loop. However, this did not interfere with the pathologic assessment. There were no significant pathologic differences between specimens according to the type of cautery used. A large degree of cautery artifact was noted in the tissue of larger tumors resected using both monopolar and bipolar electrocautery. However, the incidence and degree of cautery artifact were similar in the two groups. No trends between tumor location and degree of cautery effect were noted. The pathologist had no difficulty reaching a full and proper diagnosis in all cases involving either form of electrocautery. CONCLUSIONS: Bipolar electrocautery is well suited for TURBT. Bladder tissue obtained from bipolar TURBT is of the same histologic quality as that obtained from standard monopolar TURBT and provides the urologist with a reliable and complete diagnosis.
Between 1931 and 1971, 373 patients underwent transurethral resection of bladder tumors for cure or for control of the neoplasms. Complications included perforation of the bladder wall (5 per cent), hemorrhage requiring transfusion (13 per cent), infection (24 per cent) and postoperative mortality (1.3 per cent). Patients in whom perforations occurred had approximately twice as many infections and twice as much hemorrhage as the entire group but there were no postoperative deaths of those with perforations. Morbidity and mortality can be reduced in patients with perforation by 1) using isotonic irrigating fluid, 2) avoiding over-distension of the bladder, 3) maintaining postoperative free drainage through the catheter and 4) diagnosing and treating hyponatremia.
This report describes two cases of severe adductor muscle spasm during transurethral resection of bladder tumours and subsequent successful management with the help of obturator nerve block. Obturator nerve blocks are useful during surgery to remove large, advanced tumours in the distal lateral wall of the bladder.
A stenosis of the ureteral meatus may result from transurethral resection (TUR) for bladder tumor. Open reconstructive surgery is not recommended because of possible tumor implantation. Preservation of the renal function is the main goal, particularly when chemotherapy with nephrotoxic drugs is planned. Moreover, the patency of the vesicoureteral junction has to be preserved to allow regular inspection of the upper urinary tract for urothelial tumor. The first measure is decompression by nephrostomy. After antegrade cannulation of the stenotic ureteral meatus, a ureteral stent is left for several weeks prior to transurethral meatotomy, which is also followed by stenting for 6 weeks. The retrograde approach will fail more frequently. Sixteen ureteral meatal stenoses were treated in 11 patients. The vesicoureteral junction was permanently restored in about 50%, even when it had not only been injured by one or several TURs, but also by the preceding radio- and chemotherapy.
Two hundred and thirty one patients who underwent transurethral resection of a bladder tumor (TUR-Bt) at our hospital during the past 15 years were analyzed. There were 176 males and 55 females, and the average age at the initial TUR-Bt was 62 years old. Histopathologically, 225 cases were of transitional cell carcinoma, 4 cases of papilloma and 2 cases of squamous cell carcinoma. Grading and staging of 225 transitional cell carcinoma cases revealed grades 1, 2 and 3 in 32, 132 and 21 cases, and stages Ta, T1, T2, T3 and T2-4M1 in 48, 135, 20, 17 and 11 cases, respectively. The frequency of TUR-Bt varied from 1 to 10 times. Among the 231 cases TUR-Bt was done once, twice and three times in 149 (64.5%) and 41 (17.8%), and 22 (9.6%) cases, respectively and the total number of TUR-Bt was 400 times. The duration of the TUR-Bt operation was from 5 min. to 160 min. (mean: 32.4 min.) and the resected weight of tumor between 0.5 g and 85 g (mean: 5.4 g). As a complication of TUR-Bt, TUR-fulguration was necessary to control postoperative bleeding in 7 cases (1.7%), and blood transfusion was required in 13 cases (3.3%) during TUR-Bt. Postoperatively blood transfusion was required in 8 cases (2%), intraperitoneal perforation in 2 cases (0.5%), extraperitoneal perforation in 6 cases (1.5%) and hyponatremia in 1 case (0.3%).(ABSTRACT TRUNCATED AT 250 WORDS)
This investigation compares the short and long-term administration of intravesical Epodyl (etoglucid), following transurethral bladder tumor resection. This chemoprophylactic agent was used specifically in the treatment of bladder tumors that displayed different associated tumor risk factors: solitary versus multiple tumors, grade(s) I-III, primary versus recurrent tumors, and the presence of associated dysplasia. Within this study, 114 patients with carcinoma of the bladder underwent primary transurethral resection (TUR), followed in 10 days by short-term intravesical therapy (STIT) or long-term intravesical therapy (LTIT). Short-term intravesical therapy was administered to 56 patients. The therapy consisted of a 1% solution of Epodyl, which was given once per week for 6 weeks. Long-term intravesical therapy was given to 58 patients. This consisted of the short-term intravesical therapy protocol, followed by an additional dose once a month during an observation period of 2 years. The follow-up in both groups was for a minimum of 2 years. When the total number of recurrences in patients receiving (STIT) or (LTIT) was compared, no marked differences were noted (39% vs 38%). However, there was a difference when the individual tumor risk features were compared, e.g. for solitary tumors, the recurrence rate was 67% within the (STIT) group and 43% within the (LTIT). These results demonstrate that the decision of whether superficial bladder carcinomas are to be treated with short- or long-term Epodyl should be based on tumor-associated risk factors. Furthermore, if multiple tumor risk factors are present, maximal therapy is require; in the absence of risk factors TUR alone may be sufficient.
OBJECTIVE: To investigate fibronectin levels in urine samples from patients with noninvasive transitional cell carcinoma (TCC) of the bladder immediately and for 4 weeks after transurethral resection of bladder tumour (TURBT), to determine whether soluble fibronectin within the bladder, which blocks the attachment of bacillus Calmette-Guérin (BCG), might lower the efficacy of BCG therapy over this period. PATIENTS AND METHODS: Urinary fibronectin was measured using an enzyme-linked immunosorbent assay in 25 patients with superficial bladder TCC who underwent TURBT for complete resection. Eight samples were collected for each patient, one before and seven during the 4 weeks after TURBT. RESULTS: High levels of urinary fibronectin were detected in 18 patients (72%) after TURBT. In 16 patients the fibronectin level returned to normal within 2 weeks of surgery. The other two patients showed elevated levels of fibronectin for > 4 weeks. CONCLUSIONS: These results show that urinary fibronectin concentration is significantly increased in most patients after TURBT and this should be considered in patients who receive BCG therapy. Treatment within the first 2 weeks after TURBT may be associated with a high failure rate, as urinary fibronectin levels were increased significantly in about three-quarters of these patients during that period. Indeed, the persistent elevation of fibronectin, occurring in two of the present patients, may be responsible for some of the failures of BCG therapy when it is administered 2-5 weeks after surgery.
In a randomized trial 2 groups of 28 patients who had undergone transurethral resection of bladder tumors were treated with 20 mg. mitomycin C alone or with 200,000 units hyaluronidase to determine whether adjuvant hyaluronidase would improve tumor recurrence rates. Patient groups were comparable statistically. In the group receiving additive hyaluronidase the percentage of tumor recurrences was decreased significantly (p less than 0.05). Side effects were not increased. Thus, adjuvant hyaluronidase appears to have a role in the metaphylaxis of bladder tumors. The potential reduction of the hyaluronidase dose without loss of protective action and the role of additive hyaluronidase in the systemic treatment of metastatic urothelial tumors remain to be investigated.
PURPOSE: We evaluated the effect of simultaneous transurethral resection of bladder tumor (TURBT) and benign prostatic hyperplasia (TURP) on recurrences at the bladder neck and prostatic urethra. MATERIAL AND METHODS: During the 10-year study period 51 patients fulfilled the entry criteria of past simultaneous TURBT and TURP, histologically confirmed transitional cell carcinoma of the bladder and benign prostatic hyperplasia, a preserved bladder and a minimal followup of 12 months. Their records were analyzed retrospectively. Patients were divided into 28 with single (group 1) and 23 with multiple (group 2) bladder tumors. RESULTS: During the 12 to 120 months of followup (mean 37.3) the average tumor recurrence rate was 68.6%, that is 53.6% in group 1 and 86.9% in group 2. Recurrences appeared within an average of 14.9 months, that is within 18 (range 4 to 36) in group 1 and 13.5 (range 3 to 36) in group 2. Tumor recurrence was at the bladder neck and/or prostatic urethra in 11 of the 51 cases (21.5%). Average time to recurrence at the prostatic fossa was 23.8 months, that is 27 (range 13 to 46) in group 1 and 21.6 (range 4 to 60) in group 2. Only 1 patient had a single recurrence in the prostatic fossa, while the others also had synchronous and metachronous recurrences at other bladder sites. Tumor progression to invasiveness was diagnosed in 3 of the 51 patients (5.9%). CONCLUSIONS: Our data indicate that simultaneous TURBT and TURP do not negatively affect tumor recurrence at the bladder neck and prostatic urethra.
OBJECTIVES: To analyze the impact of transurethral resection of bladder tumor (TURBT) on the outcome of patients with bladder cancer who undergo subsequent cystectomy. METHODS: We reviewed the records of 90 patients with pathologic Stage T2 or less transitional cell carcinoma of the bladder at our institute. Before radical cystectomy, TURBT was performed for diagnostic and therapeutic purposes in all patients. We used the term "complete TURBT" in the following situations: no residual tumor endoscopically after TURBT, the presence of a muscle layer in the TURBT specimen, and no gross residual tumor in the cystectomy specimen as evaluated by a pathologist. RESULTS: No statistically significant differences in the completeness of TURBT were observed by age, sex, tumor multiplicity, shape, history of previous TURBT, tumor grade, or stage. Of 21 patients with superficial bladder tumors who had undergone incomplete resection, 14 (66.7%) had a higher stage on the cystectomy specimen; 3 (17.7%) of 17 patients had a higher stage in the complete TURBT group. Of 34 patients with an invasive tumor who underwent complete TURBT, 10 (29.4%) had an identical pathologic stage after cystectomy; the remaining patients had a lower stage. However, only 3 (16.7%) of 18 patients had a lower stage in the incomplete resection group. Of patients with Stage T2, those with pT0 stage had a better chance of survival than those with residual tumor (P = 0.04). CONCLUSIONS: Our findings indicate that the completeness of TURBT is an important aspect of patient outcome in cases of superficial or invasive bladder cancer.
We report 4 cases of severe urinary obstruction after abdominal stress incontinence procedures in women. The operative procedure consisted in transurethral resection of the obstructive, overcorrected dorsal bladder neck. After resection of the highly elevated bladder neck between the 3- and 9-o'clock position in the dorsal lithotomy position, the patients were able to regain a normal micturition without residual urine. There was no recurrence of stress incontinence.