Clinical and laboratory features of bladder explosion: a rare complication of transurethral prostatic procedures
- Authors: Zubkov I.V.1,2, Sevryukov F.A.3, Goloviznin Y.V.2, Korotaev P.N.1,2, Ovsyukov A.A.2, Kozvonin V.A.1,4, Burkov A.A.4, Semenychev D.V.3
-
Affiliations:
- FGBOU VO Kirov State Medical University of the Ministry of Health of the Russian Federation
- Private Clinical Hospital "Russian Railways – Medicine" in Kirov
- FGBOU VO Privolzhsky Research Medical University of the Ministry of Health of the Russian Federation
- FGBOU VO Vyatka State University
- Issue: No 3 (2025)
- Pages: 53-58
- Section: Endourology
- URL: https://journals.eco-vector.com/1728-2985/article/view/687831
- DOI: https://doi.org/10.18565/urology.2025.3.53-58
- ID: 687831
Cite item
Open Access
Access granted
Abstract
Introduction. 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.
Aim. 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.
Materials and methods. 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 Jané syringe. Gas composition analysis was carried out by gas chromatography on a GC-2014 chromatograph (Shimadzu, Japan) in a physico-chemical analysis laboratory.
Results. 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.
Conclusions. 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 o’clock position, and use of a morcellator to evacuate adenomatous tissue after enucleation.
Full Text
About the authors
Ivan V. Zubkov
FGBOU VO Kirov State Medical University of the Ministry of Health of the Russian Federation; Private Clinical Hospital "Russian Railways – Medicine" in Kirov
Author for correspondence.
Email: ivanzub1999@yandex.ru
ORCID iD: 0000-0002-9169-8410
Ph.D., Associate Professor of the Department of General Surgery, FGBOU VO Kirov State Medical University of the Ministry of Health of the Russian Federation; Head of the Department of Urology, Private Clinical Hospital "Russian Railways - Medicine" in Kirov
Russian Federation, 610098, Kirov, Karl Marx St., 112; 610001, Kirov, Oktyabrsky Ave., 151Fedor A. Sevryukov
FGBOU VO Privolzhsky Research Medical University of the Ministry of Health of the Russian Federation
Email: fedor_sevryukov@mail.ru
ORCID iD: 0000-0001-5120-2620
Ph.D., MD, Professor, Professor of the Department of Urology named after E.V. Shakhov
Russian Federation, 603950, Nizhny Novgorod, Minin and Pozharsky Square, 10/1Yuri V. Goloviznin
Private Clinical Hospital "Russian Railways – Medicine" in Kirov
Email: yura.gol822@gmail.ru
ORCID iD: 0009-0006-7603-8947
urologist of the Department of Urology
Russian Federation, 610001, Kirov, Oktyabrsky pr., 151Pavel N. Korotaev
FGBOU VO Kirov State Medical University of the Ministry of Health of the Russian Federation; Private Clinical Hospital "Russian Railways – Medicine" in Kirov
Email: pk-kirov@bk.ru
ORCID iD: 0009-0008-8267-8566
Ph.D., assistant of the Department of General Surgery of the FGBOU VO Kirov State Medical University of the Ministry of Health of the Russian Federation
Russian Federation, 610098, Kirov, Karl Marx St., 112; 610001, Kirov, Oktyabrsky Ave., 151Aleksey A. Ovsyukov
Private Clinical Hospital "Russian Railways – Medicine" in Kirov
Email: 03109310kl@bk.ru
ORCID iD: 0009-0004-8631-0292
urologist of the second category of the Department of Urology
Russian Federation, 610001, Kirov, Oktyabrsky pr., 151Valery A. Kozvonin
FGBOU VO Kirov State Medical University of the Ministry of Health of the Russian Federation; FGBOU VO Vyatka State University
Email: va_kozvonin@vyatsu.ru
ORCID iD: 0000-0002-2447-6949
Scopus Author ID: 57189245704
Ph.D., senior researcher of the “Biomonitoring Laboratory” of the FGBOU VO Vyatka State University; associate professor of the Department of Biology of the FGBOU VO Kirov State Medical University of the Ministry of Health of the Russian Federation
Russian Federation, 610098, Kirov, st. Karl Marx, 112; 610000, Kirov, Moskovskaya str., 36Andrey A. Burkov
FGBOU VO Vyatka State University
Email: aa_burkov@vyatsu.ru
ORCID iD: 0000-0002-3627-1262
Scopus Author ID: 57190949784
Ph.D., associate professor of the Department of Chemistry and Technology of Polymer Processing
Russian Federation, 610000, Kirov, Moskovskaya St., 36Dmitry V. Semenychev
FGBOU VO Privolzhsky Research Medical University of the Ministry of Health of the Russian Federation
Email: dsemenychev@yandex.ru
ORCID iD: 0000-0002-2804-9020
Ph.D., assistant of the Department of Urology, Faculty of Continuing Professional Education
Russian Federation, 603950, Nizhny Novgorod, Minin and Pozharsky square, 10/1References
- Aromire O.K. et al. Benign prostatic hyperplasia and sexual function. Rostov-on-Don: Phoenix, 2001. Russian (Аромире O.K. и др. Доброкачественная гиперплазия простаты и половая функция. Ростов-на-Дону: Феникс, 2001).
- Shpilenya E.S., Shaderkina V.A. Economic aspects of treating benign prostatic hyperplasia. Eksperimental’naya i klinicheskaya urologiya. 2018;2:84–89. Russian (Шпиленя Е.С., Шадеркина В.А. Экономические аспекты лечения доброкачественной гиперплазии предстательной железы. Экспериментальная и клиническая урология. 2018;2:84–89).
- Zaharushkina T.S., Abojan I.A., Pavlov S.V. Quality of life of patients suffering from benign prostatic hyperplasia. Social’naja i klinicheskaja psihiatrija. 2002;1:77–80. Russian (3ахарушкина Т.С., Абоян И.А., Павлов С.В. Качество жизни пациентов, страдающих доброкачественной гиперплазией простаты. Социальная и клиническая психиатрия. 2002;1:77–80).
- Apolikhin O.I., Sevryukov F.A., Sorokin D.A., Karpuhin I.V., Puchkin A.B., Semenichev D.V., Kochkin A.D. Dynamics and prognosis of the benign prostatic hyperplasia morbidity in Nizhegorodsky region. Eksperimental’naya i klinicheskaya urologiya. 2013;3:4–7. Russian (Аполихин О.И., Севрюков Ф.А., Сорокин Д.А., Карпухин И.В., Пучкин А.Б., Семёнычев Д.В., Кочкин А.Д. Динамика и прогнозы заболеваемости доброкачественной гиперплазией предстательной железы в Нижегородской области. Экспериментальная и клиническая урология. 2013;3:4–7).
- Lopatkin N.A. (red.). Prostate adenoma. 2-e izd. M.; 1999. Russian (Лопаткин Н.А. (ред.). Аденома предстательной железы. 2-е изд. М.; 1999).
- Martov A.G., Lopatkin N.A. Guide to transurethral endoscopic electrosurgery for prostate adenoma. M.: TriadaH; 1997. 95–103. Russian (Мартов А.Г., Лопаткин Н.А. Руководство по трансуретральной эндоскопической электрохирургии аденомы простаты. М.: ТриадаХ; 1997. 95–103).
- Madersbacher S., Marbergerr M. Is transurethral resection of the prostate still justifi ed. Br. J. Urol. Int. 1999;83:227–237.
- Sevryukov F.A. Transurethral resection in saline solution Urologija. 2012;2:67–70. Russian (Севрюков Ф.А. Трансуретральная резекция в физиологическом растворе. Урология. 2012;2:67–70).
- Sevryukov F.A., Sorokin D.A., Karpukhin I.V., Puchkin A.B., Semenychev D.V., Kochkin A.D. Transurethral Enucleation of Prostate (TUEB) – New Option in Bipolar endoscopic Surgery of BPH Eksperimental’naya i klinicheskaya urologiya. 2012;2:34–36. Russian (Севрюков Ф.А., Сорокин Д.А., Карпухин И.В., Пучкин А.Б., Семенычев Д.В., Кочкин А.Д. Трансуретральная энуклеация предстательной железы (TUEB) – новый метод биполярной эндоскопической хирургии ДГПЖ. Экспериментальная и клиническая урология. 2012;2:34–36).
- Semenichev D.V., Sevryukov F.A., Sorokin D.A., Karpukhin I.V., Puchkin A.B., Kochkin A.D. Our experience with bipolar vaporesection of the prostate in treatment of benign prostatic hyperplasia Eksperimental’naya i klinicheskaya urologiya. 2014;2:49–53. Russian (Семенычев Д.В., Севрюков Ф.А., Сорокин Д.А., Карпухин И.В., Пучкин А.Б., Кочкин А.Д. Опыт применения биполярной вапорезекции предстательной железы (TUVRB) в лечении ДГПЖ. Экспериментальная и клиническая урология. 2014;2:49–53).
- Martov A.G., Kornienko S.I., Guschin B.L., Ergakov D.V., Sazonov O.A. Intraoperative urological complications in transurethral surgical interventions on the prostate for benign hyperplasia. Urologiia. 2005;4:3–8.
- Cassuto A. Explosion dans la vessie au cours d’une electrocoagulation. The Journal of Urology. 1926;22:263.
- Hambleton B.F., Lackey R.W., Van Duzen R.E. Explosive gases formed during electrotransurethral resections. The Journal of the American Medical Association. 1935;4:645–646.
- Ning T.C. Jr., Atkins D.M., Murphy R.C. Bladder explosions during transurethral surgery. Journal of Urology. 1975;114(4):536–539.
- Astahov A.V., Platonov I.A., Platonov V.I., Kolesnichenko I.N. Application of gas chromatography in medicine. Analitika. 2023;13(6):456–461. Russian (Астахов А.В., Платонов И.А., Платонов В.И., Колесниченко И.Н. Применение газовой хроматографии в медицине. Аналитика. 2023;13(6):456–461).
- PND F 13.1:2:3.27-99. Quantitative chemical analysis of atmospheric air and atmospheric emissions. Methodology for measuring mass concentrations of carbon monoxide and methane in atmospheric air, work area air and industrial emissions using the method of reaction gas chromatography – https://docs.cntd.ru/document/1200102231. Russian (ПНД Ф 13.1:2:3.27-99. Количественный химический анализ атмосферного воздуха и выбросов в атмосферу. Методика выполнения измерений массовых концентраций оксида углерода и метана в атмосферном воздухе, воздухе рабочей зоны и промышленных выбросах методом реакционной газовой хроматографии – https://docs.cntd.ru/document/1200102231).
- Troshin K.Ya., Belyaev A.A., Arutyunov A.V., Tsarenko A.A., Nikitin A.V., Arutyunov V.S. The influence of pressure on the self-ignition delay of methane–hydrogen–air mixtures Gorenie i vzryv. 2020;13(1):18–32. doi: 10.30826/CE20130102. Russian (Трошин К.Я., Беляев А.А., Арутюнов А.В., Царенко А.А., Никитин А.В., Арутюнов В.С. Влияние давления на самовоспламенение метановодородных смесей с воздухом. Горение и взрыв. 2020;13(1):18–32. DOI:10.30826/ CE20130102).
Supplementary files
