Department of Urology, Fundació Puigvert, Barcelona, Spain.
Department of Surgery, Autonomous University of Barcelona, Barcelona, Spain.
World J Urol. 2023 Oct;41(10):2583-2589. doi: 10.1007/s00345-022-04052-w. Epub 2022 Jun 4.
Bladder perforation (BP) is the most important intraoperative adverse event of transurethral resection of bladder tumor (TURBT). It is frequently underreported despite its impact on the postoperative course. There is no standardized classification of BP. The study aims to develop a classification of the depth of endoscopic bladder perforation during TURBT.
This is a sub-analysis of a prospective randomized trial enrolling 248 patients submitted to en-bloc vs conventional TURBT from 03/2018 to 06/2021. The DEpth of Endoscopic Perforation (DEEP) scale is as follows: "0" visible muscular layer with no perivesical fat; "1" visible muscle fibers with spotted perivesical fat; "2" exposition of perivesical fat; "3" intraperitoneal perforation. Logistic and linear regression models were used to investigate predictors of high-grade perforations (DEEP 2-3) and to assess whether the DEEP scale independently predicted patients' postoperative outcomes.
A total of 146/248 (58.9%), 56/248 (22.6%), 41/248 (16.5%), 5/248 (2.0%) patients presented DEEP grade 0, 1, 2, and 3, respectively. Female gender [B coeff. 0.255 (95% CI 0.001-0.513); p = 0.05], tumor location [B coeff. 0.188 (0.026-0.339); p = 0.015], and obturator-nerve reflex [B coeff. 0.503 (0.148-0.857); p = 0.006] were independent predictors of DEEP. The scale predicted independently major complications [Odd Ratio (OR) 2.221 (1.098-4.495); p = 0.026], no post-operative chemotherapy intravesical instillation [OR 9.387 (2.434-36.200); p = 0.001], longer irrigation time [B coeff. 0.299 (0.166-0.441); p < 0.001] and hospital stay [B coeff. 0.315 (0.111-0.519); p = 0.003].
The DEEP scale provides a visual tool for grading bladder perforation during TURBT, which can help physicians standardize complication reporting and plan postoperative management accordingly.
膀胱穿孔（BP）是经尿道膀胱肿瘤切除术（TURBT）中最重要的术中不良事件。尽管它会影响术后过程，但仍经常漏报。BP 目前尚无标准化的分类。本研究旨在制定 TURBT 过程中膀胱内镜穿孔深度的分类。
这是一项前瞻性随机试验的子分析，该试验纳入了 2018 年 3 月至 2021 年 6 月期间接受整块切除术与常规 TURBT 的 248 例患者。内镜穿孔深度（DEEP）量表如下：“0”可见肌层，无膀胱周围脂肪；“1”可见肌纤维，有零星膀胱周围脂肪；“2”暴露膀胱周围脂肪；“3”腹腔内穿孔。使用逻辑和线性回归模型来研究高级别穿孔（DEEP 2-3）的预测因素，并评估 DEEP 量表是否能独立预测患者的术后结局。
248 例患者中，0 级、1 级、2 级和 3 级分别为 146/248（58.9%）、56/248（22.6%）、41/248（16.5%）和 5/248（2.0%）。女性[B 系数 0.255（95%CI 0.001-0.513）；p=0.05]、肿瘤位置[B 系数 0.188（0.026-0.339）；p=0.015]和闭孔神经反射[B 系数 0.503（0.148-0.857）；p=0.006]是 DEEP 的独立预测因素。该量表可独立预测主要并发症[比值比（OR）2.221（1.098-4.495）；p=0.026]、无术后膀胱内化疗灌注[OR 9.387（2.434-36.200）；p=0.001]、更长的冲洗时间[B 系数 0.299（0.166-0.441）；p<0.001]和住院时间[B 系数 0.315（0.111-0.519）；p=0.003]。
DEEP 量表为 TURBT 期间膀胱穿孔分级提供了一个直观的工具，有助于医生规范并发症报告，并相应地计划术后管理。
