Poletajew Sławomir, Ilczuk Tomasz, Krajewski Wojciech, Niemczyk Grzegorz, Cyran Agata, Białek Łukasz, Radziszewski Piotr, Górnicka Barbara, Kryst Piotr
Second Department of Urology, Centre of Postgraduate Medical Education, 80 Cegłowska St., 00809, Warsaw, Poland.
Department of Pathology, Medical University of Warsaw, Warsaw, Poland.
World J Surg Oncol. 2020 Aug 19;18(1):216. doi: 10.1186/s12957-020-01992-8.
Transurethral resection of the bladder tumour (TUR) is associated with a risk of bladder perforation. The underlying mechanisms and risk factors are not fully understood. The aim of this study was to determine if the bladder wall structure affects the risk of bladder perforation during TUR.
Fifteen patients who underwent TUR complicated by a bladder perforation (group 1) and fifteen matched controls who underwent uncomplicated TUR (group 2) were retrospectively enrolled in this morphological analysis. Surgical specimens were collected from all participating patients to describe the quality and architecture of urothelium and bladder submucosa. Immunohistochemical studies were performed with primary mouse anti-human E-cadherin, beta-catenin, type IV collagen, cytokeratin 20 and epithelial membrane antigen antibodies. The intensity of the immunohistochemical reaction was assessed using an immunoreactive score (IRS). Ultrastructural examinations were performed by transmission electron microscopy. The microscopic assessment was focused on the intensity of fibrosis in the bladder submucosa and the presence of degenerative changes in the urothelium.
Patients' age, sex distribution, tumour diameters, surgeon experience or cancer stage did not differ between study groups. The immunohistochemical analysis did not reveal statistically significant differences between group 1 and group 2. From a clinical point of view, ultrastructural analysis by electron microscopy showed a higher rate of severe fibrosis in group 1 (63.6% vs. 38.5%), with no differences in the rate and degree of urothelial changes. However, these differences were not statistically significant (p = 0.32).
Bladder perforation during TUR is not a result of a deficient structure of the bladder wall. Based on available evidence, the surgical technique seems to play the most important role in its prevention.
经尿道膀胱肿瘤切除术（TUR）存在膀胱穿孔风险。其潜在机制和危险因素尚未完全明确。本研究旨在确定膀胱壁结构是否会影响TUR期间膀胱穿孔的风险。
回顾性纳入15例TUR并发膀胱穿孔的患者（第1组）和15例TUR未并发穿孔的匹配对照患者（第2组）进行形态学分析。收集所有参与患者的手术标本，以描述尿路上皮和膀胱黏膜下层的质量和结构。使用小鼠抗人E-钙黏蛋白、β-连环蛋白、IV型胶原、细胞角蛋白20和上皮膜抗原抗体进行免疫组织化学研究。使用免疫反应评分（IRS）评估免疫组织化学反应的强度。通过透射电子显微镜进行超微结构检查。微观评估重点在于膀胱黏膜下层纤维化的强度以及尿路上皮退变改变的存在情况。
研究组之间患者的年龄、性别分布、肿瘤直径、外科医生经验或癌症分期无差异。免疫组织化学分析未显示第1组和第2组之间存在统计学显著差异。从临床角度来看，电子显微镜超微结构分析显示第1组严重纤维化发生率更高（63.6%对38.5%），尿路上皮改变的发生率和程度无差异。然而，这些差异无统计学意义（p = 0.32）。
TUR期间的膀胱穿孔并非膀胱壁结构缺陷所致。基于现有证据，手术技术在预防膀胱穿孔方面似乎起着最重要的作用。
