Simultaneous transurethral resection of bladder tumour and prostate: is it safe?

OBJECTIVES: This study aims to review and assess the safety of carrying out transurethral resection of prostate (TURP) and transurethral resection of bladder tumour (TURBT) simultaneously, in men who require TURP for bladder outflow obstruction and are incidentally found to have a transitional cell carcinoma of the bladder. METHODS: A detailed Medline search between 1966 and 2005 identified only five published papers in the English literature addressing this subject. These were retrospective studies of small numbers and were analysed together in order to quantify the risk of bladder cancer recurrence that could be attributed to TURP. The anatomical area of interest for tumour recurrence was hence the bladder neck and prostatic urethra. RESULTS: 424 patients had simultaneous TURBT and TURP, whereas 350 had TURBT alone. The rate of recurrence of bladder tumour in these two groups of patients was 58 and 63%, respectively. The recurrence rate at the bladder neck and prostatic urethra was equally comparable. Tumour grade and multiplicity do not appear to influence the tumour recurrence rate when TURP is carried out at the same time as TURBT. CONCLUSIONS: There is paucity of clinical evidence to support the theoretical risk of tumour cell implantation at the bladder neck and prostatic urethra when TURP is carried out at the time of TURBT.

Upper urinary tract complications in pregnant women with an ileal conduit. Lessons learned from two cases.

We describe the occurrence of severe upper urinary tract complications during pregnancy in two women with an ileal conduit. The first patient developed several episodes of left pyelonephritis throughout the duration of her pregnancy but never received proper antibiotic prophylaxis. Intravenous urography performed after delivery documented bilateral staghorn kidney stones and a non-functioning left kidney. The second patient developed severe left loin pain and a high temperature during the fourth month of pregnancy after discontinuing antibiotic prophylaxis. An MRI urogram demonstrated compression of the ureter by the foetus. Symptoms were relieved as soon as the antibiotic prophylaxis was resumed and the pain remained under control with the occasional use of paracetamol until delivery. Based on these observations it appears that the left upper urinary tract may be more prone to dilatation in pregnant patients with an ileal conduit and antibiotic prophylaxis is mandatory throughout the duration of the pregnancy in order to minimize the risk of severe upper urinary tract complications.