Bladder perforation following intravesical mitomycin C instillation after the transurethral resection of &nbsp;bladder tumor: A case report and mini‑review of the literature&nbsp;

Bapir,Rawa; Hama Hussein,Karokh F.; Ali,Rawa M.; Omar,Sami Saleem; Aghaways,Ismaeel; Rahman,Dalshad Hama Khurshid; Sabah,Choman; Rashid,Rezheen J.; Saida,Bnar Sardar; Qadir,Abdullah A.; Abdullah,Hiwa O.; Hama,Nali H.; Kakamad,Fahmi H.

doi:10.3892/wasj.2026.484

July-August 2026 Volume 8 Issue 4

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July-August 2026 Volume 8 Issue 4

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Case Report Open Access

Bladder perforation following intravesical mitomycin C instillation after the transurethral resection of bladder tumor: A case report and mini‑review of the literature

Authors:
- Rawa Bapir
- Karokh F. Hama Hussein
- Rawa M. Ali
- Sami Saleem Omar
- Ismaeel Aghaways
- Dalshad Hama Khurshid Rahman
- Choman Sabah
- Rezheen J. Rashid
- Bnar Sardar Saida
- Abdullah A. Qadir
- Hiwa O. Abdullah
- Nali H. Hama
- Fahmi H. Kakamad
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Affiliations: Department of Urology, Smart Health Tower, Sulaymaniyah 46001, Iraq, Department of Gastroenterology, Gastroenterology and Hepatology Teaching Hospital, Sulaymaniyah 46001, Iraq, Department of Pathology, Smart Health Tower, Sulaymaniyah 46001, Iraq, Kscien Organization for Scientific Research (Middle East Office), Sulaymaniyah 46001, Iraq, College of Medicine, University of Sulaimani, Sulaymaniyah 46001, Iraq, Department of Urology, Surgical Teaching Hospital, Sulaymaniyah 46001, Iraq, Department of Radiology, Smart Health Tower, Sulaymaniyah 46001, Iraq, Department of Nephrology, Smart Health Tower, Sulaymaniyah 46001, Iraq, Department of General Surgery, Smart Health Tower, Sulaymaniyah 46001, Iraq

Copyright: © Bapir et al. This is an open access article distributed under the terms of Creative Commons Attribution License [CC BY 4.0].
Article Number: 69
|
Published online on: May 25, 2026

https://doi.org/10.3892/wasj.2026.484
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Abstract

Bladder perforation following mitomycin C (MMC) instillation post‑transurethral resection of a bladder tumor (TURBT) represents a rare, yet clinically significant complication, with limited documented cases reported in the literature. The present case report describes a case of bladder perforation due to MMC instillation post‑TURBT. A 61‑year‑old male patient underwent TURBT followed by MMC instillation for the treatment of low‑grade papillary urothelial (transitional) cell carcinoma. Subsequently, he presented with severe suprapubic pain and dysuria. Computed tomography cystography demonstrated the presence of a bladder perforation, necessitating surgical intervention via laparotomy. A histopathological examination (HPE) of the perforation site revealed inflammatory changes. Following the initial laparotomy, the patient experienced persistent leak and collection, prompting a surgical procedure. A HPE, following the second laparotomy, demonstrated extensive fibrosis, chronic inflammation and necrotizing cystitis, consistent with drug‑induced cystitis. Subsequent follow‑up assessments demonstrated a gradual improvement in the clinical condition of the patient. In addition, herein, a literature review identified six reports on complications following MMC instillation post‑TURBT; with equal gender distribution. Their ages ranged from 48 to 79 years. The clinical presentation included severe and excruciating lower abdominal pain and pelvic pain, irritative urinary symptoms, hydronephrosis and pudendal neuralgia. As regards management, 3 out of the 5 patients reported in the literature had undergone surgical interventions, such as exploratory laparotomy, bladder defect repair, TURBT, ureteric stenting and radical cystectomy. The other two cases were initially managed conservatively with antibiotics and indwelling catheters. On the whole, MMC instillation immediately after TURBT is a well‑established method for reducing tumor recurrence. However, awareness of potential consequences, such as bladder perforation, is essential.

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1	Bray F, Ferlay J, Soerjomataram I, Siegel RL, Torre LA and Jemal A: Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 68:394–424. 2018.PubMed/NCBI View Article : Google Scholar
2	Babjuk M, Böhle A, Burger M, Capoun O, Cohen D, Compérat EM, Hernández V, Kaasinen E, Palou J, Rouprêt M, et al: EAU guidelines on non-muscle-invasive urothelial carcinoma of the bladder: Update 2016. Eur Urol. 71:447–461. 2017.PubMed/NCBI View Article : Google Scholar
3	Babjuk M, Burger M, Capoun O, Cohen D, Compérat EM, Dominguez Escrig JL, Gontero P, Liedberg F, Masson-Lecomte A, Mostafid AH, et al: European Association of Urology guidelines on non-muscle-invasive bladder cancer (Ta, T1, and carcinoma in situ). Eur Urol. 81:75–94. 2022.PubMed/NCBI View Article : Google Scholar
4	Hall MC, Chang SS, Dalbagni G, Pruthi RS, Seigne JD, Skinner EC, Wolf JS Jr and Schellhammer PF: Guideline for the management of nonmuscle invasive bladder cancer (stages Ta, T1, and Tis): 2007 update. J Urolo. 178:2314–2330. 2007.PubMed/NCBI View Article : Google Scholar
5	Alrabadi A, Abuhamad M, Mansi H, Alhamss S, Bustami N, Al Demour S and Al-Abbadi MA: Delayed bladder perforation related to immediate single dose intravesical doxorubicin instillation after TURBT: A case report and literature review. Clin Med Insights Case Rep. 14(1179547620986158)2021.PubMed/NCBI View Article : Google Scholar
6	Penna M, Mistry K, Pal P and Sudhanshu C: Intravesical instillation of mitomycin C: A cause of delayed bladder perforation? Case Rep Urol. 2012(576519)2012.PubMed/NCBI View Article : Google Scholar
7	EAU Guidelines. Edn. Presented at the EAU Annual Congress Amsterdam 2020. ISBN 978-94-92671-07-3.
8	Chemi J, Jaunarena JH, Camean J, Azuri W, Villaronga A and Villoldo GM: Post-Transurethral resection of bladder tumor bladder perforation resulting in mitomycin C Extravasation, pudendal neuralgia, and ureterohydronephrosis. J Endourol Case Rep. 6:315–318. 2020.PubMed/NCBI View Article : Google Scholar
9	Oehlschlager S, Loessnitzer A, Froehner M, Hakenberg OW, Manseck A and Wirth MP: Distal ureteral stenosis after early adjuvant intravesical mitomycin C application for superficial bladder cancer. Urol Int. 70:74–76. 2003.PubMed/NCBI View Article : Google Scholar
10	Lim D, Izawa JI, Middlebrook P and Chin JL: Bladder perforation after immediate postoperative intravesical instillation of mitomycin C. Can Urol Assoc J. 4:E1–E3. 2010.PubMed/NCBI View Article : Google Scholar
11	Farling KB: Bladder cancer: Risk factors, diagnosis, and management. Nurse Pract. 42:26–33. 2017.PubMed/NCBI View Article : Google Scholar
12	Babjuk M, Burger M, Capoun O, Cohen D, Compérat EM, Escrig JLD, Gontero P, Liedberg F, Masson-Lecomte A, Mostafid AH, et al: EAU Guidelines on non-muscle-invasive bladder cancer (Ta, T1, and CIS). Eur Urol. 71(447)2017.
13	Chang SS, Boorjian SA, Chou R, Clark PE, Daneshmand S, Konety BR, Pruthi R, Quale DZ, Ritch CR, Seigne JD, et al: Diagnosis and treatment of non-muscle invasive bladder cancer: AUA/SUO guideline. J Urol. 196:1021–1029. 2016.PubMed/NCBI View Article : Google Scholar
14	Clark T, Chang SS and Cookson MS: Eosinophilic cystitis presenting as a recurrent symptomatic bladder mass following intravesical mitomycin C therapy. J Urol. 167(1795)2002.PubMed/NCBI
15	Hatem H and Leifeld J: A rare complication of intravesical early instillation of mitomycin C after TURBT. Urol Case Rep. 26(100955)2019.PubMed/NCBI View Article : Google Scholar
16	Shapiro O, Jones K, Wang C, Landas S and Haas GP: Risk of post-operative intravesical mitomycin C instillation following transurethral bladder tumor resection. Can J Urol. 13:3317–3320. 2006.PubMed/NCBI

Journals

International Journal of Molecular Medicine

International Journal of Oncology

Molecular Medicine Reports

Oncology Reports

Experimental and Therapeutic Medicine

Oncology Letters

Biomedical Reports

Molecular and Clinical Oncology

World Academy of Sciences Journal

International Journal of Functional Nutrition

International Journal of Epigenetics

Medicine International

Bladder perforation following intravesical mitomycin C instillation after the transurethral resection of bladder tumor: A case report and mini‑review of the literature

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