One immediate postoperative instillation of chemotherapy in low risk Ta,T1 bladder cancer patients. Is it always safe?

Objective: The optimal treatment for solitary low grade, low stage papillary bladder tumours consists of transurethral resection (TUR) followed by one immediate postoperative instillation with a chemotherapeutic drug. However, when during TUR a bladder perforation or a near-perforation occurs, instillation of a chemotherapeutic drug may lead to leakage outside the bladder, possibly causing severe morbidity. So far, few case reports dealing with complications using mitomycin C have been published, but severe complications of leakage after an early adjuvant instillation with epirubicin have not been reported. Methods: We describe 3 patients in whom we observed serious complications of one immediate postoperative instillation of epirubicin. Results: Two of the patients recovered after conservative therapy, one patient died due to multi organ failure after explorative laparotomy. Conclusion: In order to prevent such complications, an immediate postoperative instillation has to be avoided when there is overt or even suspicion of bladder wall perforation. (C) 2004 Elsevier B.V. All rights reserved.