Intraperitoneal bladder explosion during transurethral surgery.

Transurethral resection of prostate (TURP) is the most common operation performed for obstruction secondary to prostatic enlargement. Though considered as a safe procedure, occasionally life-threatening complications may be seen. Intravesical explosion, secondary to ignition by diathermy of the accumulated mixture of hydrogen, hydrocarbons and higher concentration of oxygen, is a rarely reported complication (only 38 cases reported until). We are reporting a 60-year-old man suffering from benign prostatic hyperplasia in whom during TURP bladder explosion occurred which was suspected early and immediately explored and repaired leading to a favourable outcome.

Bladder Explosion during Transurethral Resection of the Prostate Repaired Laparoscopically: A Case Report and Review of the Literature.

OBJECTIVE: To report on a case of intravesical explosion during transurethral resection of the prostate (TURP) which was managed laparoscopically and to review the relevant literature. CLINICAL PRESENTATION AND INTERVENTION: During TURP, a loud explosion was heard, and a jolt was felt in the abdomen. A bladder tear was seen endoscopically. Systematic laparoscopic exploration showed no injury to abdominal organs apart from the irregular large bladder tear which was repaired laparoscopically. The patient had an uneventful recovery. CONCLUSION: Bladder explosion during TURP is an extremely rare and serious complication. It should be considered as a blast injury and systematic exploration of abdominal organs and vessels should be performed. The severity and urgency of the condition should not preclude the use of laparoscopy for exploration and repair.

Risk of continuous bladder irrigation in the monoplace hyperbaric chamber: a cautionary tale.

We previously published our method of performing continuous bladder irrigation (CBI) in a monoplace hyperbaric chamber [1]. This method entailed the use of an IV pump to infuse saline into the monoplace chamber. The specter of causing iatrogenic rupture of the bladder was raised following such a case, reported herein, of a woman with hemorrhagic radiation cystitis leading to cystectomy. Due to the danger of bladder rupture while providing CBI with a pump, we retract ourpreviously reported method and encourage the use of either a gravity-fed system or delay in hyperbaric oxygen therapy treatment until CBI is no longer necessary.

Bladder explosion, a rare complication following transurethral resection of the prostate.

We present a man aged 69 years who suffered from bladder explosion during transurethral resection of the prostate. Exploratory laparotomy was performed and the bladder was primarily repaired with running sutures. This patient was discharged without symptoms of urinary dysfunction on day 8 after operation. We provide prevention methods that can decrease the risk of this important complication.

The protective effect of Moringa oleifera leaves against cyclophosphamide-induced urinary bladder toxicity in rats.

Cyclophosphamide (CP), an alkylating antineoplastic agent is widely used in the treatment of solid tumors and B-cell malignant disease. It is known to cause urinary bladder damage due to inducing oxidative stress. Moringa oleifera (Mof) is commonly known as drumstick tree. Moringa leaves have been reported to be a rich source of ß-carotene, protein, vitamin C, calcium, and potassium. It acts as a good source of natural antioxidants; due to the presence of various types of antioxidant compounds such as ascorbic acid, flavonoids, phenolics and carotenoids. The aim of this work was to test the possible antioxidant protective effects of M. oleifera leaves against CP induced urinary bladder toxicity in rats. Female Wister albino rats were divided into 4 groups. Group I served as control, received orally normal saline, group II received a single dose CP 100mg/kg intraperitoneally, group III and VI both received orally hydroethanolic extract of Mof; 500 mg/kg and 1000 mg/kg respectively daily for a week, 1h before and 4h after CP administration. Rats were sacrificed 24h after CP injection. The bladder was removed, sectioned, and subjected to light, transition electron microscopic studies, and biochemical studies (measuring the parameter of lipid peroxidation; malondialdehyde along with the activities of the antioxidant enzyme reduced glutathione). The bladders of CP treated rats showed ulcered mucosa, edematous, hemorrhagic, and fibrotic submucosa by light microscopy. Ultrastructure observation showed; losing large areas of uroepithelium, extended intercellular gaps, junction complexes were affected as well as damage of mitochondria in the form of swelling and destruction of cristae. Biochemical analysis showed significant elevation of malondialdhyde, while reduced glutathione activity was significantly lowered. From the results obtained in this work, we can say that Moringa leaves play an important role in ameliorating and protecting the bladder from CP toxicity.

Explosion of the urinary bladder during transurethral resection of the prostate.

Transurethral resection of the prostate (TURP) remains the gold standard for the surgical treatment of benign prostatic hyperplasia. Complications during the procedure are rare. An extremely rare complication is a rupture of the urinary bladder. This article reports a case where an explosion occurred during TURP, resulting in a large intraperitoneal rupture of the urinary bladder. The patient underwent emergency laparotomy to repair the bladder.

[Bladder injury during sling operation in the treatment of SUI--review of literature and case report]. / Uszkodzenie pecherza moczowego w trakcie operacji slingowej w leczeniu nietrzymania moczu--przeglad literatury i opis przypadku.

INTRODUCTION: Sling operations have been performed for over 15 years. In recent years these operations have become the gold standard in the treatment of stress urinary incontinence (SUI) due to their efficacy safety and low invasiveness. Approximately 4% of women will undergo a surgery for SUI in the course of their life. As with any surgical intervention, there may be some technical problems, as well as intra- and postoperative complications, the most common of which is bladder injury Other complications encountered during mid-urethral slings procedures include bleeding (retropubic or vaginal hematomas), urethral perforation, urinary tract infections, postoperative vaginal or urethral erosions, bowel perforation, chronic pelvic pain, wound infection, nerve injury transient and persistent voiding dysfunction such as de novo urgency incomplete bladder emptying or urinary retention. Below we present a case of a patient with diagnosed vesicovaginal fistula after sling operation (TVT-tension-free vaginal tape). Upon admission the patient reported dysuria, persistent urinary leakage and abnormal, abundant vaginal discharge. OBJECTIVES: Case report and review of literature concerning surgical treatment of stress urinary incontinence and its complications. MATERIALS AND METHODS: Analysis of medical documentation of the patient treated at the Second Department of Gynecology Medical University of Lublin. Review of abstracts or papers in the Medline database related to surgical treatment of urinary incontinence and its complications. CONCLUSIONS: Bladder perforation is one of the most common complications of the retropubic approach for MUS placement. The presence of mesh within the bladder may arise from direct bladder perforation or from subsequent erosion of the sling. Such lesions do not cause any serious health consequences for patients on condition they are detected intraoperatively and appropriately repaired, but when unrecognized, they results in the development of considerable symptoms and negatively influence the quality of patient life. Improperly treated, it can lead to development of an abnormal communication between the urinary bladder and the anterior wall of the vagina -vesicovaginal fistula. We should suspect unrecognized bladder injury in case of patients with any persistent voiding symptoms after a sling procedure such as long lasting dysuria, persistent urinary leakage, hematuria, recurrent infections, chronic pain and voiding difficulties. Diagnosis and treatment of vesicovaginal fistula is long lasting and difficult for the patient and the surgeon. Füth-Mayo operation is an effective treatment method for the majority of vesicovaginal fistulas. During this operation we suture all layers of fistula separately (bladder perivesical fascia and vaginal wall). Although with this operation we solve one problem, the patient still might suffer from recurrent SUI. Alternative methods of treatment which can be offered to patients after unsuccessful SUI operation are periurethral injections with bulking agents or electrical stimulation of the pelvic floor muscles. Both methods are effective in the therapy of recurrent SUI. In our case periurtehral injection of Bulkamid did not provide a total cure. Therefore, we completed the treatment with electrical stimulation of the pelvic floor muscles using patient-controlled electrodes placed in the vagina to stimulate muscles with current frequency of 50 Hz, amperage between 0-60 mA and duration of 250 micros. This procedure produced a series of changes in the stimulated area and enabled to cure the incontinence.

Thresholds for thermal damage to normal tissues: an update.

The purpose of this review is to summarise a literature survey on thermal thresholds for tissue damage. This review covers published literature for the consecutive years from 2002-2009. The first review on this subject was published in 2003. It included an extensive discussion of how to use thermal dosimetric principles to normalise all time-temperature data histories to a common format. This review utilises those same principles to address sensitivity of a variety of tissues, but with particular emphasis on brain and testis. The review includes new data on tissues that were not included in the original review. Several important observations have come from this review. First, a large proportion of the papers examined for this review were discarded because time-temperature history at the site of thermal damage assessment was not recorded. It is strongly recommended that future research on this subject include such data. Second, very little data is available examining chronic consequences of thermal exposure. On a related point, the time of assessment of damage after exposure is critically important for assessing whether damage is transient or permanent. Additionally, virtually no data are available for repeated thermal exposures which may occur in certain recreational or occupational activities. For purposes of regulatory guidelines, both acute and lasting effects of thermal damage should be considered.

Bladder perforation associated with hot tub.

INTRODUCTION: Bladder perforation is a rare and life-threatening event. Timely diagnosis may prevent further injury-related morbidity and mortality. Aim. To present a case of bladder injury associated with masturbation in a hot tub. METHODS: This report describes a case of bladder perforation in a 54-year-old female who presented to the emergency department 2 days after masturbation with a water jet. RESULTS: Following percutaneous drainage and intraoperative closure of the bladder, the patient was discharged on postoperative day four and has had no sequelae. CONCLUSION: Cross-sectional imaging and cystography can facilitate immediate diagnosis and expeditious treatment of bladder injury associated with masturbation in a hot tub.

[Obturator nerve block]. / Blockade des Nervus obturatorius - Techniken und Indikationen.

Obturator nerve block is commonly used for transurethral resections of the bladder in order to inhibit reflectory adductor muscle reaction during electrocoagulation and to reduce the risk of bladder wall perforation during transurethral surgery. Furthermore, obturator block is used to complete regional blocks for major knee surgery in addition to femoral and sciatic nerve blocks. Continuous techniques are sometimes used to treat chronic pain problems such as adductor spasm. During a so called "3 in 1" block (femoral nerve block) the obturator nerve will only be anaesthetized in 0-62% of the patients. Therefore, a specific approach to the obturator nerve is deemed appropriate. In addition, an accessory branch of the obturator nerve will accompany the femoral nerve in 10-30% of the patients. The classical approach uses the tuberculum pubicum as an anatomical landmark, inserting the needle approximately 1.5cm lateral and caudal until bone contact is established. After laterocaudal redirection the canalis obturatorius is reached and the local anaesthetic is injected. The alternative approach is more often used: At the proximal tendon insertion of the adductor longus muscle the needle is introduced and advanced towards the anterior superior iliac spine. For both approaches a nerve stimulator is used and 15-20ml of local anaesthetic solution are injected.

Involvement of nitric oxide in microcirculatory reactions after ischemia-reperfusion of the rat urinary bladder.

BACKGROUND: Nitric oxide (NO) plays a role in inflammation. Our aim was to investigate the role of NO in the microcirculatory changes after ischemia-reperfusion (I/R) of the bladder using intravital videomicroscopy (IVM). METHODS: In rats, 60 min of bladder ischemia followed by 30 min of reperfusion was performed in the presence of N(G)-nitro-L-arginine methyl ester (L-NAME), the NO precursor L-arginine, or saline pre-treatments. Venular red blood cell velocity (RBCV), functional capillary density (FCD), vessel diameters, and leukocyte-endothelial cell interactions in postcapillary venules were determined. Concentrations of nitrite/nitrate in the plasma and myeloperoxidase (MPO) levels in the lungs and the bladder were measured. RESULTS: Elevations of the numbers of rolling and adherent leukocytes, and of plasma nitrite/nitrate levels were found, while FCD and RBCV decreased. L-NAME pretreatment ameliorated the enhanced leukocyte-endothelial cell interactions without influencing the microcirculatory perfusion. In contrast, the L-arginine pretreatment further increased plasma nitrite/nitrate levels and preserved the FCD and RBCV, but did not affect leukocyte-endothelial interactions. None of these treatments influenced MPO activities. CONCLUSION: Our results suggest that NO plays an enhancing role in the I/R-induced neutrophil-endothelial interactions of the bladder. Supplementation of NO ameliorates the microcirculatory perfusion deficit without influencing the postischemic microcirculatory inflammatory reactions.

Explosive gas formation during transurethral resection of the prostate (TURP).

Intravesical explosion during transurethral resection of the prostate (TURP) is an extremely rare event. It might be associated with various degrees of bladder injury ranging from simple mucosal tear to rupture of the bladder. It is believed that intravesical explosion occurs due to formation of explosive gases in the bladder during TURP and its admixture with air. One case of intravesical explosion during TURP resulting in complete intra- and extraperitoneal bladder rupture at our institution is described. The management of this dreaded complication involves open surgery. Although rare, this complication is preventable by taking precautions.

Surgical tip to prevent bladder perforation during transurethral resection of bladder tumors.

INTRODUCTION: Transurethral resection of bladder tumors is performed for the treatment of bladder cancer. We describe our surgical technique for transurethral resection of bladder tumors. It is easy to control the tissue depth of resection using the lateral resecting portion of the conventional right-angle loop electrode. TECHNICAL CONSIDERATIONS: Since April 2006, we have performed this technique on 57 consecutive lesions in 37 patients. The surgeon rotates the resectoscope and uses the lateral resecting portion of the right-angle loop electrode to control the tissue depth during transurethral resection. The tissue depth of resection can be precisely controlled by the surgeon using this technique. No bladder perforation or uncontrollable bleeding was observed. CONCLUSIONS: The described surgical tip is a safe technique to prevent bladder perforation during transurethral resection of bladder tumors.

Laser bladder perforation from photoselective vaporization of prostate resulting in rhabdomyolysis induced acute renal failure.

Hyponatremia and its related comorbidities remain a concern after traditional transurethral resection of the prostrate (TURP). Photoselective vaporization of the prostate (PVP) laser coagulation therapy is a new, relatively bloodless procedure for treatment of benign prostatic hyperplasia (BPH). Perceived benefits with PVP laser TURP include excellent visualization of the operative field during urethral prostatic tissue vaporization and the reduced incidence of laser penetration through the prostatic capsular fibers once the capsule is reached. Theoretically, this would provide a low risk method of perforation during laser TURP. After literature review, we report this as the first case of laser bladder perforation as a complication arising from PVP therapy. This case report discusses the management of acute hyponatremic induced rhabdomyolysis with acute renal failure (ARF) and the recommendation to use sodium chloride vs. sterile water for bladder irrigation during PVP TURP procedures.