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Research
Sławomir Poletajew
Centre of Postgraduate Medical Education
Corresponding Author
ORCiD: https://orcid.org/0000-0001-7664-9816
License:
This work is licensed under a CC BY 4.0 License. Read Full License
Background
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 bladder wall structure affects the risk of bladder perforation during TUR.
Methods
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 into 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 bladder submucosa and the presence of degenerative changes in the urothelium.
Results
Patients’ age, sex distribution, tumour diameters, surgeon experience or cancer stage did not differ between study groups. Immunohistochemical analysis did not reveal statistically significant differences between group 1 and group 2. From clinical point of view, ultrastructural analysis by electron microscopy showed 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).
Conclusions
Bladder perforation during TUR is not a result of deficient structure of the bladder wall. Based on available evidence, surgical technique seems to play the most important role in its prevention.
Keywords
Electron microtomography, Intraoperative complications, Transurethral resection, Urinary bladder, Ultrastructure
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CURRENT STATUS: Published
View the published article at World Journal of Surgical Oncology.
Version 2
Posted 06 Aug, 2020
No community comments so far
Editorial decision: Accept
On 04 Aug, 2020
Reviewer #2 agreed
On 03 Aug, 2020
Review #2 received
Received 03 Aug, 2020
Reviewer #1 agreed
On 03 Aug, 2020
Review #1 received
Received 03 Aug, 2020
Reviewers invited
Invitations sent on 30 Jul, 2020
Editor assigned
On 29 Jul, 2020
Submission checks complete
On 28 Jul, 2020
Editor invited
On 28 Jul, 2020
No comments provided
Editorial decision: Major Revision
On 28 Jun, 2020
Review #2 received
Received 25 Jun, 2020
Reviewer #2 agreed
On 18 Jun, 2020
Review #1 received
Received 04 Jun, 2020
Reviewer #1 agreed
On 22 May, 2020
Reviewers invited
Invitations sent on 18 May, 2020
Editor assigned
On 13 May, 2020
First submitted
On 12 May, 2020
Submission checks complete
On 12 May, 2020
Editor invited
On 12 May, 2020
Metrics
Comments: 0
PDF Downloads: ...
HTML Views: ...
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A new preprint design is coming!
We have improved readability, clarity, accessibility, and opportunities for engagement.
See the published version of this preprint at World Journal of Surgical Oncology.
This is a preprint, a preliminary version of a manuscript that has not completed peer review at a journal. Research Square does not conduct peer review prior to posting preprints. The posting of a preprint on this server should not be interpreted as an endorsement of its validity or suitability for dissemination as established information or for guiding clinical practice.
Learn more about In Review
Research
Sławomir Poletajew
Centre of Postgraduate Medical Education
Corresponding Author
ORCiD: https://orcid.org/0000-0001-7664-9816
Badges
Prescreen
This manuscript passed our Prescreen assessment
Complete author information
Appropriate declaration statements
Potential risks to human health
Prescreen
Peer Review Timeline
CURRENT STATUS: Published
View the published article at World Journal of Surgical Oncology.
Version 2
Posted 06 Aug, 2020
No community comments so far
Editorial decision: Accept
On 04 Aug, 2020
Reviewer #2 agreed
On 03 Aug, 2020
Review #2 received
Received 03 Aug, 2020
Reviewer #1 agreed
On 03 Aug, 2020
Review #1 received
Received 03 Aug, 2020
Reviewers invited
Invitations sent on 30 Jul, 2020
Editor assigned
On 29 Jul, 2020
Submission checks complete
On 28 Jul, 2020
Editor invited
On 28 Jul, 2020
No comments provided
Editorial decision: Major Revision
On 28 Jun, 2020
Review #2 received
Received 25 Jun, 2020
Reviewer #2 agreed
On 18 Jun, 2020
Review #1 received
Received 04 Jun, 2020
Reviewer #1 agreed
On 22 May, 2020
Reviewers invited
Invitations sent on 18 May, 2020
Editor assigned
On 13 May, 2020
First submitted
On 12 May, 2020
Submission checks complete
On 12 May, 2020
Editor invited
On 12 May, 2020
Metrics
Comments: 0
PDF Downloads: ...
HTML Views: ...
License:
This work is licensed under a CC BY 4.0 License. Read Full License
View the published article at World Journal of Surgical Oncology.
Background
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 bladder wall structure affects the risk of bladder perforation during TUR.
Methods
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 into 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 bladder submucosa and the presence of degenerative changes in the urothelium.
Results
Patients’ age, sex distribution, tumour diameters, surgeon experience or cancer stage did not differ between study groups. Immunohistochemical analysis did not reveal statistically significant differences between group 1 and group 2. From clinical point of view, ultrastructural analysis by electron microscopy showed 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).
Conclusions
Bladder perforation during TUR is not a result of deficient structure of the bladder wall. Based on available evidence, surgical technique seems to play the most important role in its prevention.
Figure 1
Figure 2
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