Download PDF
Aktuelle Urol 2020; 51(05): 450-455
DOI: 10.1055/a-1210-2163
Übersicht

Komplikationsmanagement bei der TUR-Blase

Complication management for TUR of the bladder
David Mally
1   Universitätsklinikum Düsseldorf, Klinik für Urologie, Düsseldorf
,
Pia Paffenholz
2   Universitätsklinikum Köln, Klinik für Urologie, Köln
› Author Affiliations
› Further Information
Also available at
    Permissions and Reprints

Zusammenfassung

Die transurethrale Resektion der Harnblase (TUR-Blase) ist ein Standardeingriff der operativen Urologie. Eine komplette Resektion steht hierbei an höchster Stelle. Darüber hinaus ist die Kenntnis der möglichen Komplikationen und das dazugehörige Komplikationsmanagement für die klinische Praxis essenziell. Zu den häufigsten Komplikationen gehören katheterassoziierte Beschwerden, Blutungen, Infektionen und die Harnblasenperforation. Doch auch die Resektion des Harnleiterostiums und Lagerungsschäden stellen zwar seltenere, aber dennoch unmittelbar behandlungswürdige Komplikationen dar. In der vorliegenden Übersichtsarbeit werden diese Komplikationen zusammengefasst sowie deren Vorbeugung und Management vorgestellt.

Abstract

Transurethral resection of bladder cancer is a standard procedure in urology which requires complete resection. Knowledge of the possible complications and their management is essential for practicing urologists. The most common complications are catheter related bladder symptoms, bleeding, infections and perforation of the bladder. Resection of the orifice and positional damage are seldom but severe complications which need immediate treatment. In this review, we summarise the above mentioned complications as well as their management.

Schlüsselwörter

TUR-Blase - Komplikationen - Blutung - Infektion - Perforation

Keywords

transurethral resection of the bladder - perforation - infection - bleeding - complications


Publication History

Article published online:
12 August 2020

© Georg Thieme Verlag KG
Stuttgart · New York

 

  • Literatur

  • 1 Robert-Koch-Institut. Harnblasenkrebs. Zentrum für Krebsregisterdaten; 2019
    PubMedGoogle Scholar
  • 2 Avallone MA. et al. Ten-Year Review of Perioperative Complications After Transurethral Resection of Bladder Tumors: Analysis of Monopolar and Plasmakinetic Bipolar Cases. J Endourol 2017; 31: 767-773
    CrossrefPubMedGoogle Scholar
  • 3 Brausi M. 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
    CrossrefPubMedGoogle Scholar
  • 4 Mariappan P. et al. Detrusor Muscle in the First, Apparently Complete Transurethral Resection of Bladder Tumour Specimen Is a Surrogate Marker of Resection Quality, Predicts Risk of Early Recurrence, and Is Dependent on Operator Experience. European Urology 2010; 57: 843-849
    CrossrefPubMedGoogle Scholar
  • 5 Babjuk M. et al. European Association of Urology Guidelines on Non-muscle-invasive Bladder Cancer (TaT1 and Carcinoma In Situ) - 2019 Update. Eur Urol 2019; 76: 639-657
    CrossrefPubMedGoogle Scholar
  • 6 Kramer MW. et al. Current Evidence of Transurethral En-bloc Resection of Nonmuscle Invasive Bladder Cancer. Eur Urol Focus 2017; 3: 567-576
    CrossrefPubMedGoogle Scholar
  • 7 Gregg JR. et al. Short term complications from transurethral resection of bladder tumor. Can J Urol 2016; 23: 8198-8203
    PubMedGoogle Scholar
  • 8 Liu H. et al. Comparison of the safety and efficacy of conventional monopolar and 2-micron laser transurethral resection in the management of multiple nonmuscle-invasive bladder cancer. J Int Med Res 2013; 41: 984-992
    CrossrefPubMedGoogle Scholar
  • 9 D'Souza NA. Verma, Holmium laser transurethral resection of bladder tumor: Our experience. Urol Ann 2016; 8: 439-443
    CrossrefPubMedGoogle Scholar
  • 10 Agarwal A. et al. Ketamine for treatment of catheter related bladder discomfort: a prospective, randomized, placebo controlled and double blind study. Br J Anaesth 2006; 96: 587-589
    CrossrefPubMedGoogle Scholar
  • 11 Li S. et al. Tramadol for the treatment of catheter-related bladder discomfort: a randomized controlled trial. BMC Anesthesiol 2018; 18: 194
    CrossrefPubMedGoogle Scholar
  • 12 Agarwal A. et al. The efficacy of tolterodine for prevention of catheter-related bladder discomfort: A prospective, randomized, placebo-controlled, double-blind study. Anesthesia and Analgesia 2005; 101: 1065-1067
    CrossrefPubMedGoogle Scholar
  • 13 Binhas M. et al. Predictors of catheter-related bladder discomfort in the post-anaesthesia care unit. Ann Fr Anesth Reanim 2011; 30: 122-125
    CrossrefPubMedGoogle Scholar
  • 14 Ryu JH. et al. Efficacy of butylscopolamine for the treatment of catheter-related bladder discomfort: a prospective, randomized, placebo-controlled, double-blind study. Br J Anaesth 2013; 111: 932-937
    CrossrefPubMedGoogle Scholar
  • 15 Kim DH. et al. Intravenous Lidocaine for the Prevention of Postoperative Catheter-Related Bladder Discomfort in Male Patients Undergoing Transurethral Resection of Bladder Tumors: A Randomized, Double-Blind, Controlled Trial. Anesth Analg 2020; 131: 220-227 DOI: 10.1213/ANE.0000000000004405.
    CrossrefPubMedGoogle Scholar
  • 16 Collado A. et al. Early complications of endoscopic treatment for superficial bladder tumors. J Urol 2000; 164: 1529-1532
    CrossrefPubMedGoogle Scholar
  • 17 Picozzi S. et al. Risks and complications of transurethral resection of bladder tumor among patients taking antiplatelet agents for cardiovascular disease. Surg Endosc 2014; 28: 116-121
    CrossrefPubMedGoogle Scholar
  • 18 Wenders M. et al. Perioperative platelet inhibition in transurethral interventions: TURP/TURB. Int Braz J Urol 2012; 38: 606-610
    CrossrefPubMedGoogle Scholar
  • 19 Virseda-Rodriguez AJ. et al. Influence of antiplatelet-anticoagulant drugs on the need of blood components transfusion after vesical transurethral resection. Archivio Italiano Di Urologia E Andrologia 2015; 87: 136-140
    CrossrefPubMedGoogle Scholar
  • 20 Koscielny J. Perioperative Strategie bei ASS/Clopidogrel. Pharm. Unserer Zeit 2009; 38: 352-358
    CrossrefPubMedGoogle Scholar
  • 21 Prader R. et al. Outcome of Transurethral Resection of Bladder Tumor: Does Antiplatelet Therapy Really Matter? Analysis of a Retrospective Series. J Endourol 2017; 31: 1284-1288
    CrossrefPubMedGoogle Scholar
  • 22 Fukuhara H. et al. Safety and Efficacy of Continuous Administration of Antithrombotic Drugs during Transurethral Resection of Bladder Tumors. Nihon Hinyokika Gakkai Zasshi 2017; 108: 17-23
    PubMedGoogle Scholar
  • 23 Wada N. et al. Perioperative complications of transurethral resection of bladder tumor in patients receiving antithrombotic therapy. Hinyokika Kiyo 2014; 60: 531-535
    PubMedGoogle Scholar
  • 24 e.V., D.G.f.K.H.-u.K. Duale antithrombozytäre Therapie (DAPT) bei Koronarer Herzkrankheit, Version 2017. Grünwald: Börm Bruckmeier Verlag GmbH; 2018
    Google Scholar
  • 25 Eberli D. et al. Urological surgery and antiplatelet drugs after cardiac and cerebrovascular accidents. J Urol 2010; 183: 2128-2136
    CrossrefPubMedGoogle Scholar
  • 26 Carmignani L. et al. Endoscopic resection of bladder cancer in patients receiving double platelet antiaggregant therapy. Surg Endosc 2011; 25: 2281-2287
    CrossrefPubMedGoogle Scholar
  • 27 Gumus E. et al. Neurapraxic complications in operations performed in the lithotomy position. World J Urol 2002; 20: 68-71
    CrossrefPubMedGoogle Scholar
  • 28 Bruce RG, Kim FH, McRoberts W. Rhabdomyolysis and acute renal failure following radical perineal prostatectomy. Urology 1996; 47: 427-430
    CrossrefPubMedGoogle Scholar
  • 29 Choudhari K, Choudhari Y, Fannin T. Acute lumbar intervertebral disc prolapse: a complication of the lithotomy position. BJOG 2000; 107: 1519-1521
    CrossrefPubMedGoogle Scholar
  • 30 Moses TA, Kreder KJ, Thrasher JB. Compartment syndrome: an unusual complication of the lithotomy position. Urology 1994; 43: 746-747
    CrossrefPubMedGoogle Scholar
  • 31 Dyer J, Wyke S, Lynch C. Hospital Episode Statistics data analysis of postoperative venous thromboembolus in patients undergoing urological surgery: a review of 126,891 cases. Ann R Coll Surg Engl 2013; 95: 65-69
    CrossrefPubMedGoogle Scholar
  • 32 Gelder C. et al. A systematic review of mechanical thromboprophylaxis in the lithotomy position. Surgeon 2018; 16: 365-371
    CrossrefPubMedGoogle Scholar
  • 33 Chen IW. et al. Nonfatal pulmonary embolism associated with the use of compression stockings in the lithotomy position after spinal anesthesia. Ci Ji Yi Xue Za Zhi 2017; 29: 228-231
    PubMedGoogle Scholar
  • 34 Rausch SGG, Stenzl A. Transurethrale Resektion der Harnblase. Urologe 2014; 53: 695-698
    CrossrefPubMedGoogle Scholar
  • 35 Kranz J. et al. Epidemiology, diagnostics, therapy, prevention and management of uncomplicated bacterial outpatient acquired urinary tract infections in adult patients : Update 2017 of the interdisciplinary AWMF S3 guideline. Urologe A 2017; 56: 746-758
    CrossrefPubMedGoogle Scholar
  • 36 Bootsma AM. et al. Antibiotic prophylaxis in urologic procedures: a systematic review. Eur Urol 2008; 54: 1270-1286
    CrossrefPubMedGoogle Scholar
  • 37 Ivan SJ, Sindhwani P. Comparison of guideline recommendations for antimicrobial prophylaxis in urologic procedures: variability, lack of consensus, and contradictions. International Urology and Nephrology 2018; 50: 1923-1937
    CrossrefPubMedGoogle Scholar
  • 38 Bonkat GBR, Bruyère F, Cai T. et al. Urological Infections. EAU Guidelines 2019; 2019
    PubMedGoogle Scholar
  • 39 Balbay MD. et al. The actual incidence of bladder perforation following transurethral bladder surgery. J Urol 2005; 174: 2260-2262; discussion 2262-2263
    CrossrefPubMedGoogle Scholar
  • 40 Summerton DJKN, Lumen N, Serafetinidis E. European Association of Urology. et al. EAU guidelines on iatrogenic trauma. Eur Urol 2012; 62: 628-639
    CrossrefPubMedGoogle Scholar
  • 41 El Hayek OR. et al. Evaluation of the incidence of bladder perforation after transurethral bladder tumor resection in a residency setting. J Endourol 2009; 23: 1183-1186
    CrossrefPubMedGoogle Scholar
  • 42 Herkommer K. et al. Gender and body mass index as risk factors for bladder perforation during primary transurethral resection of bladder tumors. J Urol 2012; 187: 1566-1570
    CrossrefPubMedGoogle Scholar
  • 43 Erbay G. et al. Effect of obturator nerve block during transurethral resection of lateral bladder wall tumors on the presence of detrusor muscle in tumor specimens and recurrence of the disease. Kaohsiung J Med Sci 2017; 33: 86-90
    CrossrefPubMedGoogle Scholar
  • 44 Zhao C. et al. Bipolar Versus Monopolar Transurethral Resection of Nonmuscle-Invasive Bladder Cancer: A Meta-Analysis. J Endourol 2016; 30: 5-12
    CrossrefPubMedGoogle Scholar
  • 45 Khan A. et al. Intravesical explosions during transurethral endoscopic procedures. Int Urol Nephrol 2007; 39: 179-183
    CrossrefPubMedGoogle Scholar
  • 46 Georgios K. et al. Intravesical explosion during transurethral electrosurgery. Scott Med J 2015; 60: e25-e26
    CrossrefPubMedGoogle Scholar
  • 47 Elmamoun MH, Christmas TJ, Woodhouse CR. Destruction of the bladder by single dose Mitomycin C for low-stage transitional cell carcinoma (TCC)--avoidance, recognition, management and consent. BJU Int 2014; 113: E34-E38
    CrossrefPubMedGoogle Scholar
  • 48 Racioppi M. et al. Bladder perforation: a potential risk of early endovesical chemotherapy with mitomycin C. Urol Int 2005; 75: 373-375
    CrossrefPubMedGoogle Scholar
  • 49 Skolarikos A. et al. Does the management of bladder perforation during transurethral resection of superficial bladder tumors predispose to extravesical tumor recurrence?. J Urol 2005; 173: 1908-1911
    CrossrefPubMedGoogle Scholar
  • 50 Mano R. et al. Resection of ureteral orifice during transurethral resection of bladder tumor: functional and oncologic implications. J Urol 2012; 188: 2129-33
    CrossrefPubMedGoogle Scholar