Vesical explosion during transurethral resection of the prostate: report of a case.

OBJECTIVE Vesical perforation during transurethral resection of the prostate (TURP) is usually related to high increases in intravesical pressure. However, it may rarely be related to explosion precipitated by the contact of the electrocautery with some gases produced during the resections. The authors present a case of vesical explosion, discuss its mechanism and suggest some measures for prevention. METHODS/RESULTS A 71-years-old male underwent TURP and hemostasy of bleeding from the bladder neck due to persistent hematuria. A wire loop electrode set at a cutting and coagulating current of 80 watts was used. During coagulation of a bleeding in the anterior aspect of the vesical neck when the bladder was empty, 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. A low midline incision was done, and the intraperitoneal bladder rupture was repaired. CONCLUSION Although uncommon, vesical explosion during TURP may occur and some preventive measures, discussed herein, can be performed to avoid this complication.