Purpose: To report our experience with symptomatic extravasation of intravesical chemotherapy administered within 24 h after transurethral resection (TUR) over the past 10 years. Methods: We identified all consecutive patients who presented with symptomatic extravasation of intravesical chemotherapy following TUR between 2001 and 2011. We assessed the severity of the postoperative complications using the modified Clavien system. Results: We identified 9 patients (mean age 59, range 40–76 years) with symptomatic extravasation. One patient had grade II, 2 had grade IIIa, and 5 patients had grade IIIb complications according to the Clavien system. Surgery was needed in 6 of 9 patients. One required ICU management (Clavien IV). No patients died in the postoperative course. Conclusion: Extravasation can cause severe complications and diagnosis is often protracted. Considering the growing practice of immediate intravesical instillations, the number of patients with symptomatic extravasation is expected to rise. An increased awareness of this possible complication is warranted.

Keywords:
Non-muscle-invasive bladder cancer, Urothelial carcinoma, Intravesical chemotherapy, Extravasation
1.
Berrum-Svennung I, Granfors T, Jahnson S, Boman H, Holmang S: A single instillation of epirubicin after transurethral resection of bladder tumors prevents only small recurrences. J Urol 2008;179:101–105.
2.
Gudjonsson S, Adell L, Merdasa F, Olsson R, Larsson B, Davidsson T, et al: Should all patients with non-muscle-invasive bladder cancer receive early intravesical chemotherapy after transurethral resection? The results of a prospective randomised multicentre study. Eur Urol 2009;55:773–780.
3.
Sylvester RJ, Oosterlinck W, van der Meijden AP: A single immediate postoperative instillation of chemotherapy decreases the risk of recurrence in patients with stage Ta, T1 bladder cancer: a meta-analysis of published results of randomized clinical trials. J Urol 2004;171:2186–2190.
4.
Oosterlinck W, Kurth KH, Schroder F, Bultinck J, Hammond B, Sylvester R: A prospective European Organization for Research and Treatment of Cancer Genitourinary Group randomized trial comparing transurethral resection followed by a single intravesical instillation of epirubicin or water in single stage Ta, T1 papillary carcinoma of the bladder. J Urol 1993;149:749–752.
5.
Rajala P, Kaasinen E, Raitanen M, Liukkonen T, Rintala E: Perioperative single-dose instillation of epirubicin or interferon-α after transurethral resection for the prophylaxis of primary superficial bladder cancer recurrence: a prospective randomized multicenter study – FinnBladder III long-term results. J Urol 2002;168:981–985.
6.
Cliff AM, Romaniuk CS, Parr NJ: Perivesical inflammation after early mitomycin C instillation. BJU Int 2000;85:556–557.
7.
Dangle PP, Wang WP, Pohar KS: Vesicoenteric, vesicovaginal, vesicocutaneous fistula – an unusual complication with intravesical mitomycin. Can J Urol 2008;15:4269–4272.
8.
Fazlioglu A, Tandogdu Z, Kurtulus FO, Parlakkilic O, Cek M: Perivesical inflammation and necrosis due to mitomycin C instillation after transurethral resection of bladder tumor: we must be vigilant! Urol Int 2009;83:362–363.
9.
Nieuwenhuijzen JA, Bex A, Horenblas S: Unusual complication after immediate postoperative intravesical mitomycin C instillation. Eur Urol 2003;43:711–712.
10.
Oddens JR, van der Meijden AP, Sylvester R: One immediate postoperative instillation of chemotherapy in low risk Ta, T1 bladder cancer patients. Is it always safe? Eur Urol 2004;46:336–338.
11.
Tyritzis SI, Stravodimos KG, Mihalakis A, Constantinides CA: Complications associated with primary and secondary perforation of the bladder following immediate instillations of epirubicin after transurethral resection of superficial urothelial tumours. Int Urol Nephrol 2009;41:865–868.
12.
Constantinides CA, Tyritzis SI, Skolarikos A, Liatsikos E, Zervas A, Deliveliotis C: Short- and long-term complications of open radical prostatectomy according to the Clavien classification system. BJU Int 2009;103:336–340.
13.
Dindo D, Demartines N, Clavien PA: Classification of surgical complications: a new proposal with evaluation in a cohort of 6,336 patients and results of a survey. Ann Surg 2004;240:205–213.
14.
Novara G, De Marco V, Aragona M, Boscolo-Berto R, Cavalleri S, Artibani W, et al: Complications and mortality after radical cystectomy for bladder transitional cell cancer. J Urol 2009;182:914–921.
15.
Shabsigh A, Korets R, Vora KC, Brooks CM, Cronin AM, Savage C, et al: Defining early morbidity of radical cystectomy for patients with bladder cancer using a standardized reporting methodology. Eur Urol 2009;55:164–174.
16.
Sobin LH, Gospodarowicz MK, Wittekind CH: TNM Classification of Malignant Tumours, ed 7. New York, Wiley-Blackwell, 2009.
17.
Brausi M, Collette L, Kurth K, van der Meijden AP, Oosterlinck W, Witjes JA, et al: Variability in the recurrence rate at first follow-up cystoscopy after TUR in stage Ta T1 transitional cell carcinoma of the bladder: a combined analysis of seven EORTC studies. Eur Urol 2002;41:523–531.
18.
Babjuk M, Oosterlinck W, Sylvester R, Kaasinen E, Bohle A, Palou-Redorta J, et al: EAU guidelines on non-muscle-invasive urothelial carcinoma of the bladder, the 2011 update. Eur Urol 2011;59:997–1008.
19.
Sylvester RJ, van der Meijden AP, Oosterlinck W, Witjes JA, Bouffioux C, Denis L, et al: Predicting recurrence and progression in individual patients with stage Ta T1 bladder cancer using EORTC risk tables: a combined analysis of 2,596 patients from seven EORTC trials. Eur Urol 2006;49:466–465.
20.
Hendricksen K, Witjes WP, Idema JG, Kums JJ, Vierssen Trip OB, de Bruin MJ, et al: Comparison of three schedules of intravesical epirubicin in patients with non-muscle-invasive bladder cancer. Eur Urol 2008;53:984–991.
21.
Gudjonsson S, Adell L, Merdasa F, Olsson R, Larsson B, Davidsson T, et al: Should all patients with non-muscle-invasive bladder cancer receive early intravesical chemotherapy after transurethral resection? The results of a prospective randomised multicentre study. Eur Urol 2009;55:773–780.
22.
Dobruch J, Herr H: Should all patients receive single chemotherapeutic agent instillation after bladder tumour resection? BJU Int 2009;104:170–174.
23.
Collado A, Chechile GE, Salvador J, Vicente J: Early complications of endoscopic treatment for superficial bladder tumors. J Urol 2000;164:1529–1532.
24.
Balbay MD, Cimentepe E, Unsal A, Bayrak O, Koc A, Akbulut Z: The actual incidence of bladder perforation following transurethral bladder surgery. J Urol 2005;174:2260–2262, discussion.
25.
Doherty AP, Trendell-Smith N, Stirling R, Rogers H, Bellringer J: Perivesical fat necrosis after adjuvant intravesical chemotherapy. BJU Int 1999;83:420–423.
26.
Patel JS, Krusa M: Distant and delayed mitomycin C extravasation. Pharmacotherapy 1999;19:1002–1005.
27.
Ener RA, Meglathery SB, Styler M: Extravasation of systemic hemato-oncological therapies. Ann Oncol 2004;15:858–862.
28.
Langstein HN, Duman H, Seelig D, Butler CE, Evans GR: Retrospective study of the management of chemotherapeutic extravasation injury. Ann Plast Surg 2002;49:369–374.
29.
Pansadoro A, Franco G, Laurenti C, Pansadoro V: Conservative treatment of intraperitoneal bladder perforation during transurethral resection of bladder tumor. Urology 2002;60:682–684.
© 2012 S. Karger AG, Basel
2012
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.