Management of Bladder Perforation During TURBT

Assessment and Immediate Management

The presence of fat near the trigone and left ureter orifice during TURBT indicates bladder perforation, requiring immediate cessation of the procedure and consideration for surgical repair, according to the National Comprehensive Cancer Network 1
The visualization of fat tissue near the trigone and left ureter orifice strongly suggests a bladder perforation during the TURBT procedure, as stated by the National Comprehensive Cancer Network 1
This location is particularly concerning due to its proximity to the left ureter, which increases risk of ureteral injury and subsequent complications, as noted by the American Urological Association 2
Place a large-caliber urethral catheter (20-24 Fr) with continuous bladder drainage to manage the perforation, as recommended by the American Urological Association 2

Immediate surgical exploration is indicated due to the location near the ureter orifice, according to the National Comprehensive Cancer Network and the American Urological Association 1, 2
Laparoscopic repair of the perforation is a possible surgical intervention, as noted by the American Urological Association 2
Open surgical repair with possible ureteral reimplantation if the ureteral orifice is compromised is another option, as stated by the American Urological Association 2

The patient's advanced age increases surgical risk and may influence management decisions, as noted by the American Urological Association 3
The presence of multiple papillary tumors suggests possible bladder cancer, requiring complete staging and follow-up once the perforation is addressed, according to the National Comprehensive Cancer Network 1
DVT prophylaxis should be considered based on the patient's risk factors and the surgical approach selected, as recommended by the American Urological Association 3

Once the perforation has healed, complete the tumor resection in a staged procedure, as recommended by the National Comprehensive Cancer Network 1
Consider alternative approaches for completing the tumor resection such as bipolar TURP or laser techniques to minimize risk of repeat perforation, as noted by the American Urological Association and other guidelines 2, 4

Ureteral obstruction or stricture is a potential complication, as noted by the American Urological Association 2
Bladder neck contracture during healing is another possible complication, according to other guidelines 5

Perforations near the trigone and ureteral orifice are considered extraperitoneal but can quickly become intraperitoneal if not addressed promptly, as noted by the European Association of Urology 6

A cystogram should be performed before catheter removal to confirm healing, as recommended by the European Association of Urology 6

Complete staging of the bladder tumors should be done once the perforation is addressed, following guidelines from the National Comprehensive Cancer Network 7
Long-term surveillance should be based on the pathology of the papillary tumors, as recommended by the National Comprehensive Cancer Network 7

Urinary tract infection, which occurs more frequently following complicated procedures, is a potential complication, according to the Infectious Diseases Society of America 8