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Bladder perforation with extravasation, cellulitis, fibrosis, necrosis and inflammation occurred in two elderly men after intravesical instillation of epirubicin for bladder cancer.
An 82-year-old man underwent transurethral resection of a bladder tumour and received two epirubicin 50mL instillations within 24 and 48 hours of surgery; the catheter was clamped to hold the agent in the bladder. Instillations were well tolerated for 2 hours. He became febrile and reported abdominal fullness and malaise 24 hours after the second instillation. Retropubic cellulitis was evident, and he immediately received IV fluids and broad-spectrum antibiotics. CT with retrograde cystogram and ultrasound identified bladder perforation with...