Bladder explosion during transurethral resection of prostate: Bladder diverticula as an additional risk factor

Area of Science:

• Urology
• Surgical Complications

Background:

• Transurethral resection of the prostate (TURP) is a common procedure for benign prostatic hyperplasia.
• Vesical (bladder) explosion is an extremely rare but catastrophic complication during TURP.

Observation:

• A 75-year-old male with chronic urinary retention underwent TURP for a Grade 2 trilobar prostate enlargement.
• The patient had multiple bladder diverticula, including a large one in the bladder dome.
• During the procedure, a loud pop occurred, indicating a bladder explosion and intraperitoneal rupture.

Findings:

• The underlying mechanism of intravesical explosion involves the generation and trapping of explosive gases within the bladder, detonating upon contact with the cautery electrode.
• Despite precautions, bladder rupture occurred in this case.
• Multiple bladder diverticula are identified as a potential additional risk factor, possibly due to thinned bladder walls and air trapping within diverticula.

Implications:

• The case highlights the importance of recognizing risk factors for bladder explosion during TURP.
• Continuous drainage of air using a suprapubic trocar may be a practical preventive measure in patients with multiple bladder diverticula.
• Further research into preventing and managing this rare complication is warranted.