Intravesical explosions during transurethral endoscopic procedures

Abstract

Every Urologist, during the course of fulguration treatment of bladder tumours, has at some time or another experienced small intravesical explosions usually manifesting as a "pop". Major intravesical explosions are rare but potentially devastating complications of transurethral endoscopic resections. The damage to the bladder can range from small mucosal tears to bladder rupture, which can either be intraperitoneal (requiring laparotomy and open bladder repair) or extraperitoneal. We review the literature on intravesical explosions to determine the aetiology of these explosions and suggest strategies to prevent these. A comprehensive literature search was performed using Medline and Ovid to obtain information using search terms: intravesical explosions, transurethral procedures, endoscopic procedures, diathermyIntravesical explosions occur due to the production of explosive gases during use of diathermy on human tissues. The most dangerous combination is hydrogen and oxygen. Hydrogen alone is not explosive and it only becomes explosive when admixed with oxygen. Oxygen is not produced in sufficient quantity during diathermy to cause explosions but can enter into the bladder from the atmosphere during endoscopic procedures. Careful operative technique (correct use of the Ellick evacuator bulb and reducing the frequency of manual irrigations of the bladder) with minimisation of the operative time and using the coagulation current at moderate power as well as judicious coagulation of tissues can reduce the risk of this dangerous complication arising.

Systemic Tumor Seeding Secondary to Peritonitis due to the Immediate Postoperative Intravesical Instillation of Pirarubicin After Intravesical Explosion Induced Bladder Perforation During Bipolar Transurethral Resection of Bladder Tumors

“…Oxygen is not produced in sufficient quantity during diathermy to cause explosions but it can enter the bladder from the atmosphere during endoscopic procedures. Once hydrogen combines with oxygen, it becomes explosive and can be ignited by spark generated during electrosurgery [7].…”

Bladder Explosion, A Rare Complication of Transurethral Resection of the Prostate: Two Case Reports

“…Bladder explosion, a rare and frightful complication of TURP, is estimated to occur in approximately 0.02% of transurethral procedures (5). The degree of bladder injury due to an explosion varies from a loud "pop" sound to only a ruptured bladder requiring surgical repair (6). One of the most common causes of bladder perforation during transurethral surgery is hyper distension of the bladder wall when the amount of fluid infused is in excess, when the patient has a low vesical compliance or when excessive pressure is applied during evacuation of prostatic fragments (7).…”

Komplikationsmanagement bei der TUR-Blase

“…Die häufig gefürchtete Knallgasexplosion während einer TUR-Blase wird ausschließlich in Fallberichten beschrieben und ist somit sehr selten [45,46]. Die intravesikale Explosion entsteht, wenn sich der durch die Resektion entstandene Wasserstoff mit der Außenluft vermischt und durch bei der Resektion freiwerdende Funken entzündet wird.…”