Case report: A rare case of extravesical, extraperitoneal metastasis after transuretheral resection of urothelial carcinoma

Abstract

Bladder perforation secondary to transurethral resection of bladder tumour (TURBT) increases the risk of tumour cell seeding and eventual extravesical metastasis. Here we presented a case where a patient with localised bladder tumour was initially managed with repeated TURBTs for tumour recurrence. Subsequently he was found to have extravesical pelvic metastasis. This was likely secondary to microperforation of bladder and tumour cell seeding. Microscopic bladder perforation is difficult to diagnose. However patients with confirmed bladder perforation during TURBT would justify systemic radiological cancer surveillance in view of higher risk of metastatic disease.

Bladder Perforation during Transurethral Resection of Bladder Tumor Is Not an Innocent Accident: Literature Review Based on a Clinical Case Experience

“…Few cases resembling ours have been described in the literature by Kim [14]. Sites of metastasis were unusual such as the adnexa [11] [12], the peritoneum [11], the pelvis [13] and the sigmoid colon [14]. Time elapsed between the perforation and the recurrence discovery in these patients ranged between 4 and 15 months.…”

Rapidly Progressive Bladder Cancer Diagnosed because of Spontaneous Bladder Rupture

“…However, invasion to the ileum, lymphadenopathy, and peritoneal masses were observed on CT and MRI before cystectomy. Although bladder perforation during transurethral resection of bladder tumors is associated with an increased risk of intra-abdominal dissemination, it is very rare [ 7 , 8 ]. In the present case, peritoneal masses suspicious for dissemination developed only a few weeks after the onset of bladder rupture, which suggests the extremely malignant potential of the tumor.…”