Intravessical Fat-Fluid Level Secondary to Silent Bladder Perforation After Transurethral Resection of Urothelial Carcinoma

Abstract

Non-muscle-invasive bladder tumours are defined as papillary lesions limited to the bladder mucosa or invading the lamina propia, in addition to flat morphology and high-grade tumors limited to the mucosa (carcinoma in situ [CIS]). Diagnostic confirmation occurs after histological analysis of the sample obtained in the transurethral resection of the bladder (TURB), which in Ta-T1 tumours requires complete resection of all lesions, including part of the detrusor muscle, being in these cases also the therapeutic method. In the case of CIS, which may simulate inflammation or not be visible in cystoscopy, multiple random bladder biopsies are necessary (2). Iatrogenic bladder perforation is the second most frequent adverse event of this procedure; This solution of continuity in the wall can lead to the migration of fat into the bladder, which in imaging tests results in the formation of an intravesical fat-fluid level, a rare finding, which in turn has a broad differential diagnosis that covers primary, infectious and traumatic causes, but not previously described as a complication of TURB. We report the case of an asymptomatic patient with presence of intravesical fat-fluid, secondary to extra-peritoneal bladder perforation, after transurethral resection of a non-muscle[1]invasive urothelial carcinoma in the bladder dome.