The DEpth of Endoscopic Perforation scale to assess intraoperative perforations during transurethral resection of bladder tumor: subgroup analysis of a randomized controlled trial
Por:
Breda, A, Gallioli, A, Diana, P, Fontana, M, Territo, A, Gaya, JM, Rodriguez-Faba, O, Huguet, J, Piana, A, Verri, P, Baboudjian, M, Aumatell, J, Algaba, F, Palou, J
Publicada:
1 ene 2023
Ahead of Print:
1 jun 2022
Resumen:
Purpose 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. Methods 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. Results 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]. Conclusion 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.
Filiaciones:
Breda, A:
Fundacio Puigvert, Dept Urol, Barcelona, Spain
Autonomous Univ Barcelona, Dept Surg, Barcelona, Spain
Gallioli, A:
Fundacio Puigvert, Dept Urol, Barcelona, Spain
Diana, P:
Fundacio Puigvert, Dept Urol, Barcelona, Spain
Humanitas Res Hosp IRCCS, Dept Urol, Rozzano, Italy
Fontana, M:
Fundacio Puigvert, Dept Urol, Barcelona, Spain
Territo, A:
Fundacio Puigvert, Dept Urol, Barcelona, Spain
Gaya, JM:
Fundacio Puigvert, Dept Urol, Barcelona, Spain
Rodriguez-Faba, O:
Fundacio Puigvert, Dept Urol, Barcelona, Spain
Autonomous Univ Barcelona, Dept Surg, Barcelona, Spain
Huguet, J:
Fundacio Puigvert, Dept Urol, Barcelona, Spain
Piana, A:
Fundacio Puigvert, Dept Urol, Barcelona, Spain
Verri, P:
Fundacio Puigvert, Dept Urol, Barcelona, Spain
Baboudjian, M:
Fundacio Puigvert, Dept Urol, Barcelona, Spain
North Hosp, AP HM, Dept Urol, Marseille, France
Aumatell, J:
Fundacio Puigvert, Dept Urol, Barcelona, Spain
Algaba, F:
Autonomous Univ Barcelona, Dept Pathol, Fundacio Puigvert, Barcelona, Spain
Palou, J:
Fundacio Puigvert, Dept Urol, Barcelona, Spain
Autonomous Univ Barcelona, Dept Surg, Barcelona, Spain
Green Published, Bronze, Green
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