Transurethral Resection Syndrome After Bladder Perforation

Abstract

The use of irrigating solutions is essential for distension of mucosal surfaces and visualization of the surgical field during resectoscopic resection of bladder tumors (TURBT). TURBT resection may be complicated with bladder perforation associated with intraperitoneal extravasation of irrigant fluid, which may rarely evolve in specific hydroelectrolyte imbalance characterized with hyponatremia, intravascular volume deficit, and renal impairment. We report four cases of TURBT syndrome during bladder surgery complicated by bladder perforation and discuss issues relevant to pathophysiology, diagnosis, and treatment of this rare condition.

Acute Abdominal Compartment Syndrome following Extraperitoneal Bladder Perforation

“…This may have been beneficial due to decreasing the amount of fluid requiring diuresis and decreasing the physiological disturbance. In prior case reports of transurethral bladder perforation, all patients with extraperitoneal rupture were treated with an urgent laparotomy [3]. …”

“…There are previous short case series reports in the literature of intra-abdominal fluid accumulation following a bladder perforation [3]. All of the cases were recognized prior to completion of the surgery.…”

“…Further notable features of this case are the physiological changes related to the perforation of the bladder with a fluid overload pattern and electrolyte derangement distinct from the transurethral prostate syndrome [3]. We note the differences between the two in the Discussion.…”

Comparison of hemodynamic profiles in transurethral resection of prostate vs transurethral resection of urinary bladder tumors during spinal anesthesia: a bioimpedance study

“…Because the prostatic gland contains large venous sinuses and because of the chance for prostate capsule perforation, excessive amounts of irrigating fluids might be absorbed into the circulation during TURP [8], causing electrolyte disturbances; hypervolemia, which may deteriorate to pulmonary edema; heart failure; and even cardiorespiratory arrest [9][10][11]. If TURT patients have increased irrigating fluid absorption, it mainly occurs later, by the extravascular route (perforation of urinary bladder), which gives rise to a drop in plasma sodium level, one to 2 hours after surgery [12]. This makes it somewhat problematic to compare sodium between the groups.…”

Kasa İnvaze Olmayan Mesane Kanserinde Tur-Tm Sırasında Mesane Perforasyonu: Hastaya Erken ve Geç Dönemde Yaklaşım

“…İntraperitoneal perforasyon daha ciddi bir durumdur. Çünkü bağırsak yaralanması olasılığı ile beraber irrigasyon solusyonunun batın içine yayılıp sistemik emilimi de söz konusu olabilir (10). Bu konudaki geleneksel yaklaşım intraperitoneal perforasyon olduğu anda açık cerrahiye geçilmesi şeklindedir.…”