Komplikationsmanagement bei der TUR-Blase

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

• Literatur

• 1 Robert-Koch-Institut. Harnblasenkrebs. Zentrum für Krebsregisterdaten; 2019
• 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
• 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
• 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
• 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
• 6 Kramer MW. et al. Current Evidence of Transurethral En-bloc Resection of Nonmuscle Invasive Bladder Cancer. Eur Urol Focus 2017; 3: 567-576
• 7 Gregg JR. et al. Short term complications from transurethral resection of bladder tumor. Can J Urol 2016; 23: 8198-8203
• 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
• 9 D'Souza NA. Verma, Holmium laser transurethral resection of bladder tumor: Our experience. Urol Ann 2016; 8: 439-443
• 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
• 11 Li S. et al. Tramadol for the treatment of catheter-related bladder discomfort: a randomized controlled trial. BMC Anesthesiol 2018; 18: 194
• 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
• 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
• 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
• 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
• 16 Collado A. et al. Early complications of endoscopic treatment for superficial bladder tumors. J Urol 2000; 164: 1529-1532
• 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
• 18 Wenders M. et al. Perioperative platelet inhibition in transurethral interventions: TURP/TURB. Int Braz J Urol 2012; 38: 606-610
• 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
• 20 Koscielny J. Perioperative Strategie bei ASS/Clopidogrel. Pharm. Unserer Zeit 2009; 38: 352-358
• 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
• 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
• 23 Wada N. et al. Perioperative complications of transurethral resection of bladder tumor in patients receiving antithrombotic therapy. Hinyokika Kiyo 2014; 60: 531-535
• 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
• 25 Eberli D. et al. Urological surgery and antiplatelet drugs after cardiac and cerebrovascular accidents. J Urol 2010; 183: 2128-2136
• 26 Carmignani L. et al. Endoscopic resection of bladder cancer in patients receiving double platelet antiaggregant therapy. Surg Endosc 2011; 25: 2281-2287
• 27 Gumus E. et al. Neurapraxic complications in operations performed in the lithotomy position. World J Urol 2002; 20: 68-71
• 28 Bruce RG, Kim FH, McRoberts W. Rhabdomyolysis and acute renal failure following radical perineal prostatectomy. Urology 1996; 47: 427-430
• 29 Choudhari K, Choudhari Y, Fannin T. Acute lumbar intervertebral disc prolapse: a complication of the lithotomy position. BJOG 2000; 107: 1519-1521
• 30 Moses TA, Kreder KJ, Thrasher JB. Compartment syndrome: an unusual complication of the lithotomy position. Urology 1994; 43: 746-747
• 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
• 32 Gelder C. et al. A systematic review of mechanical thromboprophylaxis in the lithotomy position. Surgeon 2018; 16: 365-371
• 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
• 34 Rausch SGG, Stenzl A. Transurethrale Resektion der Harnblase. Urologe 2014; 53: 695-698
• 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
• 36 Bootsma AM. et al. Antibiotic prophylaxis in urologic procedures: a systematic review. Eur Urol 2008; 54: 1270-1286
• 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
• 38 Bonkat GBR, Bruyère F, Cai T. et al. Urological Infections. EAU Guidelines 2019; 2019
• 39 Balbay MD. et al. The actual incidence of bladder perforation following transurethral bladder surgery. J Urol 2005; 174: 2260-2262; discussion 2262-2263
• 40 Summerton DJKN, Lumen N, Serafetinidis E. European Association of Urology. et al. EAU guidelines on iatrogenic trauma. Eur Urol 2012; 62: 628-639
• 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
• 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
• 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
• 44 Zhao C. et al. Bipolar Versus Monopolar Transurethral Resection of Nonmuscle-Invasive Bladder Cancer: A Meta-Analysis. J Endourol 2016; 30: 5-12
• 45 Khan A. et al. Intravesical explosions during transurethral endoscopic procedures. Int Urol Nephrol 2007; 39: 179-183
• 46 Georgios K. et al. Intravesical explosion during transurethral electrosurgery. Scott Med J 2015; 60: e25-e26
• 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
• 48 Racioppi M. et al. Bladder perforation: a potential risk of early endovesical chemotherapy with mitomycin C. Urol Int 2005; 75: 373-375
• 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
• 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