Intravesical explosion during transurethral resection of bladder tumor: a case report and literature review

Intravesical explosion represents an extremely rare yet hazardous complication during transurethral resection of bladder tumors. Given that severe intravesical explosion can lead to bladder rupture, which requires further surgical intervention and even poses a potential threat to patients' life safety, this complication deserves heightened clinical attention. Herein, we present an 82-year-old male patient admitted for gross hematuria, dysuria, frequent micturition and urgent micturition lasting over 20 days. Pelvic CT revealed a 43 mm × 30 mm irregular mass on the left side of the bladder dome. He underwent transurethral resection of bladder tumors with warm 0.9% normal saline as irrigation fluid, coagulation power 120 W, resection power 200 W. At 65 minutes into the procedure, a distinct audible "pop" was heard when resecting the tumor base-bladder wall junction, with subsequent tachycardia, heart rate rising from 75 to 110 beats per minute, and failed bladder distension. Laparoscopic exploration confirmed a 50 mm irregular bladder rupture, and radical cystectomy with bilateral cutaneous ureterostomy was performed. Postoperative pathology confirmed invasive sarcomatoid carcinoma of the bladder accompanied by high-grade urothelial carcinoma. The patient recovered uneventfully with no recurrence or metastasis during 9-month follow-up. We further analyze the predisposing factors, therapeutic strategies and preventive measures of this complication by reviewing relevant literature.