[Clinical and Laboratory Features of Bladder Explosion: A Rare Complication of Transurethral Prostatic Procedures]

Currently, benign prostatic hyperplasia is a highly relevant problem. The main treatment methods are transurethral bipolar resection of the prostate (TURis) or transurethral bipolar enucleation (TUEB). One of the most serious complications during these procedures is bladder explosion.

To investigate the clinical conditions that create the risk of bladder explosion, to develop a surgical strategy for managing this complication, and to analyze the composition of the gas mixture formed intraoperatively in the bladder during transurethral procedures on the prostate.

Procedures were performed under spinal anesthesia. The PLASMA system was used for transurethral plasma enucleation and transurethral plasma resection, including a 26 Fr plasma resectoscope (Olympus), and a high-frequency generator ESG-400. Plasma electrodes were used as following: Plasma-Needle for incision, Plasma-TUEB Loop for enucleation, and Plasma-Large Loop for resection. Normal saline was used as the irrigation fluid. TUEB and TURis were performed by standard technique. At the end of the procedure, the gas sample was aspirated through the inflow channel of the resectoscope using a Jan syringe. Gas composition analysis was carried out by gas chromatography on a GC-2014 chromatograph (Shimadzu, Japan) in a physico-chemical analysis laboratory.

In addition to carbon monoxide and carbon dioxide, methane was detected in the gas sample; this formed an explosive mixture that ignited upon contact with the hot loop of the resectoscope.

Bladder explosion occurs during TUR in patients with large prostates and is independent of equipment settings. Management strategy depends on the size of the bladder rupture. To prevent bladder rupture, continuous evacuation of intravesical gases is required by advancing the resectoscope to the gas pocket and allowing fluid drainage, as well as careful monitoring of electrode activation when working at the bladder neck at the 12 oclock position, and use of a morcellator to evacuate adenomatous tissue after enucleation.