Gender and body mass index as risk factors for bladder perforation during primary transurethral resection of bladder tumors

Purpose: Bladder cancer is the second most common tumor of the genitourinary system. Although transurethral resection is the standard diagnostic and therapeutic procedure, it is not morbidity free. Bladder perforation is the second most common complication and it can lead to severe further complications. We evaluated risk factors for bladder perforation in patients treated with transurethral resection of bladder tumors.

Materials and methods: We retrospectively studied the records of 1,284 patients with bladder cancer who underwent transurethral resection of bladder tumors between 1986 and 2006. Data on risk factors for bladder perforation, including age, gender, body mass index, nicotine use, gross hematuria, transurethral catheterization, bladder stones, tumor stage and grade, number of tumors and resection weight, were analyzed with the chi-square or Fisher exact test.

Results: Of the 49 bladder perforations (3.8%) 89.8% were extraperitoneal and 10.2% were intraperitoneal. The risk of bladder perforation was associated with gender (female and male 7.2% and 2.6%, p <0.001), body mass index (less than 25, 25 to 30 and greater than 30 kg/m(2) 5.5%, 3.4% and 0.6%, p = 0.016), tumor stage (pTis, pTa, pT1 and pT2 or greater 3.7%, 2.6%, 4.5% and 6.7%, p = 0.049), infiltration depth (superficial and muscle invasive 3.2% and 6.6%, p = 0.023) and resection weight (less than 2.5 and 20 gm or greater 2.4% and 9.2%, respectively, p = 0.003). Patient age, nicotine use, gross hematuria at diagnosis, transurethral catheterization, bladder stones, number of tumors and tumor grade were not risk factors for bladder perforation.

Conclusions: Aside from tumor characteristics female gender and low body mass index were risk factors for inadvertent bladder perforation during transurethral resection of bladder tumors. Each factor is readily apparent.