What are the complications of Transitional Cell Carcinoma (TCC)?

From the Guidelines

Complications of Transitional Cell Carcinoma (TCC) include urinary tract infections, urethral injury, bleeding, false passages, or perforation, as well as long-term complications such as bladder stones, decreased bladder capacity, and urethral strictures or erosion. The most common complication is urinary tract infections (UTIs), occurring in approximately 30% of short-term catheterizations and virtually all long-term catheterizations 1. Trauma during insertion can cause urethral injury, bleeding, false passages, or perforation. Catheter blockage may occur due to encrustation, blood clots, or sediment, requiring catheter replacement. Bladder spasms are common and can be managed with anticholinergics like oxybutynin (5mg three times daily) or tolterodine (2mg twice daily) 1. Long-term complications include bladder stones, decreased bladder capacity, and urethral strictures or erosion. Catheter-associated UTIs should be treated with appropriate antibiotics based on culture results, typically for 7-14 days, with catheter replacement during treatment. Preventive measures include maintaining a closed drainage system, proper hygiene, adequate hydration, and regular catheter changes every 2-4 weeks for long-term users. Silver-coated or antibiotic-impregnated catheters may reduce infection risk in short-term use. These complications arise because catheters provide a direct route for microorganisms to enter the bladder and create biofilms on catheter surfaces, while the foreign body presence causes chronic inflammation and tissue damage over time 1. Some key points to consider in the management of TCC include:

• The use of intravesical therapy, such as bacille Calmette-Guérin (BCG) therapy, after initial transurethral resection of bladder tumor (TURBT) for high-risk disease 1
• The role of radical cystectomy as the standard treatment for patients with muscle-invasive bladder cancer, with bladder-preserving approaches as alternatives for patients who are medically unfit for surgery or seek an alternative 1
• The use of neo-adjuvant chemotherapy before cystectomy for T2 and T3 disease, with a demonstrated survival benefit 1
• The importance of maintaining a closed drainage system, proper hygiene, adequate hydration, and regular catheter changes to prevent complications 1.

From the Research

Complications of Transitional Cell Carcinoma (TCC)

• The complications of TCC can be severe and impact patient outcomes, as seen in studies 2, 3, 4, 5, 6.
• Common complications include recurrence, progression, and metastasis, with recurrence rates ranging from 27% to 44% in different studies 2, 5, 6.
• Local recurrence can occur in the retroperitoneum, bladder, or remaining upper tract, while distant metastases can occur in the lung, bone, or liver 5.
• Tumor stage and grade are significant prognostic factors for recurrence and survival, with higher stages and grades associated with poorer outcomes 3, 5, 6.
• Treatment modalities, such as radical nephroureterectomy or parenchymal sparing approaches, can also impact recurrence and survival rates 5.
• Bacille Calmette-Guérin (BCG) immunotherapy can be an effective treatment for TCC, but may be associated with complications such as bladder irritation, fever, and hematuria 2, 3, 6.

Specific Complications

• Venous tumor thrombus is a rare but serious complication of TCC, with a high mortality rate 4.
• Extension of TCC into the renal vein or inferior vena cava can occur, and requires prompt surgical intervention 4.
• Distant metastases can occur, and are often associated with poor prognosis 5, 6.
• Local recurrence can be treated with repeat BCG therapy or surgical intervention, but may require careful monitoring and follow-up 2, 6.

Prognostic Factors

• Tumor stage and grade are significant prognostic factors for recurrence and survival 3, 5, 6.
• Patient age and treatment modality can also impact prognosis, with older patients and those undergoing radical nephroureterectomy having poorer outcomes 5.
• The type of surgical procedure performed can also impact recurrence and survival rates, with radical nephroureterectomy achieving excellent local control 5.