Bladder Perforation Following Transurethral Resection of Bladder Tumor With Immediate Intravesical Instillation of Epirubicin

ABSTRACT Introduction Immediate postoperative intravesical chemotherapy following transurethral resection of bladder tumor (TURBT) is the standard procedure aimed at reducing recurrence. Case Presentation An 84‐year‐old man was diagnosed with an incidental 13‐mm intravesical tumor during screening for biochemical recurrence following radiation therapy for prostate cancer. Accordingly, he underwent TURBT, followed by immediate postoperative intravesical chemotherapy with epirubicin. On postoperative day 2, he developed abdominal pain. Computed tomography demonstrated bladder perforation accompanied by retroperitoneal free air. He was diagnosed with extraperitoneal bladder perforation and thus managed with urethral catheterization; however, conservative treatment failed. Consequently, surgical repair with debridement was performed. Pale whitish granulation tissue was observed within the perivesical fat, suggesting epirubicin extravasation. Subsequently, cystography performed 28 days after bladder repair showed no contrast extravasation. Conclusions Surgical treatment should be considered as a potential treatment option for patients with suspected chemotherapy extravasation in whom conservative management is unsuccessful.