INTRAVESICAL EXPLOSION DURING TRANSURETHRAL RESECTION OF BLADDER TUMORS

A 56-year-old white male underwent transurethral resection of bladder tumors that presented 7 years after radical retropubic prostatectomy. A 25Fr resectoscope sheath was used with a wire loop electrode set at a cutting current of 120 watts (pure cut) and a coagulating current of 80 watts. Sterile water was used as the irrigating fluid. Multiple areas of tumor within the bladder were resected and the chips were removed with simple irrigation. On final inspection a small papillary lesion at the dome was identified within the air bubble and was removed with cold cup biopsy forceps. Cauterization of the area was attempted by applying suprapubic pressure to the lower abdomen to force the dome of the bladder down into the water filled bladder. On initiation of the cautery a loud pop was heard and a jolt was felt at the lower abdomen. Inspection revealed a hole in the dome of the bladder with loops of small bowel visible. The patient was repositioned so that a low midline incision could be made, and the intraperitoneal bladder rupture was repaired. An approximately 3 cm hole near the dome of the bladder was closed in 2 layers, and the abdominal cavity was irrigated with copious amounts of sterile water. A catheter was left to drain the bladder. Postoperative course was uncomplicated and the catheter was removed after 10 days. DISCUSSION