Bladder injury during biopsy

I am new to this site and want to share my recent experience with a punctured bladder. I recently had a cystoscopy biopsy under general anesthetic and a few days later was rushed to the hospital with severe abdominal pain and swelling. The CT discovered fluid leaking into the abdomen from an injury to the bladder. I was put on a foley catheter and given morphine for the pain. I stayed in the hospital for 4 days. Finally the swelling went down and the pain subsided and I am at home now wearing the foley catheter until next Monday. The doctor is hoping the bladder will heal itself. If I wear the catheter and give the bladder a rest, perhaps it will heal on its own and surgery can be avoided. On Monday, I will have a CT done to see whether or not my bladder is healed. If not, I guess surgery will be required. The good news in all of this is that the biopsy came back negative. The unfortunate news for me is that my bladder was injured in the process. I still have a questionable FISH test result and still no explanation for the hematuria but the biopsy is negative. I am trying to educate myself as much as possible in this matter, as it has been a surreal experience so far and I am still wading through and trying to understand medical terms and tests previously unknown to me. I appreciate being able to share it on this site. If anyone has had a similar experience and/or a bladder healing I would benefit from hearing your stories. Thank you for listening.

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Well, I guess the first thing is that a punctured bladder, though not common, is always a possibility, especially if the go deep into the bladder for a better tissue sample. So that in and of itself is just an inherent risk. The FISH, well that is more of a process than a specific procedure, that is, it is used to detect more than just bladder cancer and false positives are not uncommon. The reason for the blood does need to be tracked down and it could be a number of things. I think a CT Urogram would give the best picture as it looks at the entire urinary system, kidneys, tubes, bladder etc. Overall I always highly recommend that a person have the most experienced urologist they can get, that is not to say that yours is not. I would speak with your doc about the diagnostic process and what is or her plan is. Then take it from there. I don;t think a punctured bladder is negligence, it is difficult to know how thick the bladder is. I see this as a risk that goes with the procedure. But I would look at your doc's total treatment approach to you and if you have questions or concerns then get a second opinion. I would have that biopsy looked at by another pathologist though, just to be sure. That is usually very easy to arrange and many uro docs do that routinely. Ask you doc to have another pathologist look at the slides just to be sure. And be sure to get that blood checked out. Could be a stone in the ureter or something like that. Strenuous activity sometimes can do it. But follow up is highly recommended.

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Hi,
Welcome to our family. When the medical staff brought me the paperwork to sign before a TURB one thing they always said was the possibility puncturing the bladder. One time when I was getting a TURB I wasn't "under" enough and I kicked the surgeon in the head.
Needless to say they gave me more anesthesia.
Made a little nick in the bladder, but no extra surgery. I wish you the best.
Keith

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Welcome to the community,,,,thank you for your experience,it will help others,,,,my husbands bladder is gone now,,,,nothing to puncture at this point....

it happens,
Ginger

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So Keith, you kicked your surgeon in the head. Hymmm. Bet the anesthesiologist got a good kick from the surgeon later.

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BEwellcells, welcome to the community .. you will find much support and good info on this site. Also, thank you for posting as it helps others to read what you have gone through. Sorry for your awful experience and hope you are soon feeling well. Keep us posted.
michelle

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Welcome to our loving and caring community.

You will find first hand accounts (such as you have offered) which
are very helpful and a wealth of other information to move forward.

The people here are also full of emotion and an unselfish willingness to help.

You have found a safe home for your Journey.

BJ

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Hey:

I had a perforated bladder during my last biopsy in May. My urologist retired in December and I unfortunately slid over to his young partner without shopping around. Big mistake.

The symptoms started about 4 days after the biopsy the night after I removed the catheter. I too was rushed to the hospital in excruciating pain at 4 am the same day I was supposed to meet with my oncologist and get my path report from the biopsy. I was treated with pain meds and antibiotics - had a CT to rule out appendicitis and then the contrast x-ray to check my bladder. That's when they saw the perforation.

I immediately requested a second surgical opinion since the young partner wanted to put me into repair surgery the next day. I also asked my oncologist to take over and find me a new surgeon since we knew I needed my bladder out soon and there was no way I was staying with the surgeon who just cut me open.

While I was in the hospital my oncologist met with me on the final path report and told me it was time to say goodbye to my cancer hotel - aka bladder. I trust this guy totally so we began the steps to stage me for the procedure.

The second surgeon - who immediately became my new urologist in the hospital - suggested I go home with a catheter for a month and let the bladder rest and heal itself. He said doing repair surgery would be like repairing a roof that you were going to tear down a few months later.

I am so glad your biopsy came back negative. That's the most important thing. If you can keep the catheter for a few more weeks to avoid surgery - that's the route I would take.

I had my RC about three weeks ago and I am feeling less pain then when I had the perforated bladder. Go figure - a perforation vs. major surgery. A urine leak in your abdomen can cause some pretty nasty pain as you now know. The ER people thought I was in labor because my belly was swollen and the level of pain. Ha! My husband looked scared - I think the possibility of a fourth kid (he's in his 50s) scared him more than anything!

Rest and take care of your injured bladder - avoid surgery if possible - Veronica

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thanks to all of you for your kind and supportive and informative responses. I appreciate it. What an awesome community!!

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Hi Veronica,
your response was so helpful because our experiences were so similar. I do not know what RC stands for, is that reconstructive surgery? I'm glad you are feeling well. You have such a positive attitude as well and it comes across in your postings. I am fortunate that my biopsy came back negative but I am told that I should have another pathologist review it just to be sure. Also, I still have concerns about the FISH test which came back positive. Have you had much experience with the FISH test? According to the FISH test I have more than 4 cells consistent with carcinoma but the biopsy results are negative. I'm glad about the biopsy results but also concerned about the FISH test results and wonder if perhaps I should get a second opinion. My cathether will have been in for 10 days as of Tuesday. I get a scan on Monday to make sure it's healed. If not, I will certainly consider your story and the good results you had from leaving it in longer. Surgery is such an unappealing option. thanks again for your input. best wishes to you for your good health. BWC

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BWC
Thank you for your kind words. RC stands for a radical cystectomy (for a woman this is removal of the bladder and a hysterectomy). I have had bladder cancer for eight years - but have only had a proper diagnosis for five years. In the five years I have had 19 tumors removed (six single tumors and up to 12 multiple tumors), 3 years of maintenance BCG, a kidney and ureter removed and as we discussed a punctured bladder. My bladder was war torn and scarred with all the TURB (tumor removals) and BCG treatment.

I had so much peace about removing my bladder because I had time to prepare for it mentally. I admire many online who didn't have this extra time to deal with losing their bladder. Other women like Anna, Nancy and BJ who have to first deal with the shock of a bladder cancer diagnosis and then deal with the reality of having their bladder removed immediately.

I have not had experience with a fish test - so I suggest you start a new discussion titled - Experience with a fish test?? - to seek out advice. Second opinions are always recommended. All in all - keep asking questions - and people here will help . . . and pray . . . .and cheer you on when you get good news . . . and encourage you when the news isn't so good.

Keep the faith - V

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During my first TURB, the uro hit a nerve which made my leg jerk which made him perforate my bladder. I had a foley cath because the tumour removal was so big and quite a few (5) to remove. I didn't know he had perforated it until I saw a post=op report months and months later. I'll assume they foley was to help me drain the blood and tissue debris from TURB but also I am guessing to rest the bladder from the puncture. I was in the hosital for 4 days.

I hope you recover soon and good news your biopsy was negative.

And I agree, we are an awesome community.

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JerseyGuy also had a perforated bladder during his last Turb. It was most serious since no urine was draining and it was staying inside. He had emergency surgery but came through it like a trooper. I am learning that this is not an uncommon occurence but nothing I ever thought of when I was having Turbs. I think everyone should know of the risks.
Nancy

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Hi BWC,

FISH (fluorescent in situ hybridization) is a technique used to demonstrate various "biochemicals" including certain gene products that can be useful in the diagnosis and treatment alternatives for various cancers. My understanding of the urine FISH test for bladder cancer is that it represents a cocktail of various gene products that are correlated with bladder cancer (bc). When used in conjunction with urine cytology it is said to have a quite high sensitivity (detects most cancers). High sensitivity tests usually result in some loss of specificity (this means that you have positive tests that do not exhibit the condition tested for (in this case bc). I do not recall the specificity, but I do know that not all of the highly experienced, bc "experts" use this test because of the specificity issues. The biopsy results are the true test against which these others are measured. Does a negative biopsy mean that there is 100% certainty that there is no cancer? Unfortunately, no. It too can have false negatives for various reasons, most often due to not sampling the diagnostic area. I guess with negative biopsy and negative cystoscopy, that the greatest likelihood is at this time you do not have bc. I would also think that the positive FISH would result in closer surveillance and follow up than if all had been negative. As with others, I had an apparent perforation during either biopsy or TURBT, but it was clinically inapparent and was discovered as adhesions on the bladder during rc. Best wishes,

JJ

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Thank you JJ.
this is very informative and helpful and it is my intention to follow-up with and maintain surviellance and in that regard I am fortunate to have the opportunity to know these things at such an early early stage. It appears that I do not have bc but that I have cells that could develop accordingly, hence, I will be checking and getting re-tested for the FISH test and possibly go for a 2nd opinion a little later. First, I am hoping and praying for a healed bladder next Tuesday so that I can move forward from here.
BWC

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