Mar 10, 2026
Protocol for a Scoping Review of Intravesical Bladder Explosion During Endoscopic Urologic Surgery
- Nelson Daniel Sánchez-Arroyo1,2
- 1Universidad Surcolombiana;
- 2Clínica Uros
Protocol Citation: Nelson Daniel Sánchez-Arroyo 2026. Protocol for a Scoping Review of Intravesical Bladder Explosion During Endoscopic Urologic Surgery. protocols.io https://dx.doi.org/10.17504/protocols.io.kxygxjwj4l8j/v1
License: This is an open access protocol distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited
Protocol status: Working
We use this protocol and it's working
Created: March 10, 2026
Last Modified: March 10, 2026
Protocol Integer ID: 309280
Keywords: Urinary Bladder, Rupture, Intraoperative Complications, Iatrogenic disease, Intraoperative awareness, Transurethral Resection of Prostate, Urinary Bladder Neoplasms, Cystoscopy, Endoscopy, Urologic Surgical Procedures, Male, Patient Characteristics, Risk Factors, Treatment Outcome, intravesical bladder explosion during endoscopic urologic surgery, intravesical bladder explosion, endoscopic urologic procedure, endoscopic urologic surgery, urologic surgery, ignition during electrosurgical procedure, electrosurgical procedure, endoscopic, scoping review, prisma extension for scoping review, describing intraoperative event, intraoperative event, reports of this complication
Abstract
Intravesical bladder explosion is an extremely rare but potentially serious complication reported during endoscopic urologic surgery, with current evidence mainly limited to isolated case reports and small case series describing intraoperative events related to gas accumulation and ignition during electrosurgical procedures. Given its rarity, this protocol outlines a scoping review aimed at identifying and synthesizing published reports of this complication during endoscopic urologic procedures. The review will follow the methodological framework of the Joanna Briggs Institute and will be reported according to the PRISMA Extension for Scoping Reviews (PRISMA-ScR), with the objective of mapping the existing literature and describing the technical, procedural, and clinical characteristics reported in these cases.
Image Attribution
Source: Author.
Guidelines
Scoping review conducted according to the methodological framework of the Joanna Briggs Institute (JBI) and reported following the PRISMA Extension for Scoping Reviews (PRISMA-ScR) guidelines.
Materials
**Category**
**Variable**
Normal saline
Mannitol
Dextrose
Not reported
**Irrigation flow**
Intermittent
Continuous
Not reported
**Intraoperative characteristics**
Procedure duration until explosion
Visible gas bubble (Yes / Not reported)
**Signs of bladder explosion**
Pop sound
Jolt
Pain
Hypotension
**Surgical moment**
Resection
Hemostasis
Not reported
Immediate suspicion (Yes / No)
**Diagnostic method**
Intraoperative (direct visualization)
Imaging
Both
**Bladder rupture**
Yes / No
**Location of injury**
Dome
Anterior wall
Posterior wall
Lateral wall
Base
Not specified
**Type of rupture**
Intraperitoneal
Extraperitoneal
**Bladder injury classification (adapted from AAST)**
Mild subclinical injury
Extraperitoneal rupture
Intraperitoneal rupture
**Management**
Conservative
Laparotomy
Laparoscopy
**Bladder repair**
Layered suture
Debridement
Reinforcement
Not specified
**Surgical drains**
Foley catheter
Suprapubic cystostomy
Abdominal drain
Double-J ureteral stent
Not specified
**Conservative management measures**
Foley catheter
Antibiotic therapy
Not reported
**Outcomes**
Recovery
Death
**Complications**
Respiratory failure
Post-TURP syndrome
Hemodynamic instability
Infection
Bladder dehiscence
Troubleshooting
Eligibility framework
Eligibility is defined using the Population–Concept–Context (PCC) framework: patients undergoing endoscopic urologic procedures (Population), intravesical bladder explosion (Concept), and endoscopic urologic surgery in any clinical setting (Context).
Inclusion and exclusion criteria
Case reports and case series describing intravesical bladder explosion during endoscopic urologic surgery in humans were included without restrictions on age, sex, language, or publication year. Reviews, animal studies, editorials without case descriptions, and reports where the event could not be clearly identified were excluded.
Search strategy
A systematic search will be conducted in PubMed, Scopus, DOAJ, and SciELO, complemented by manual screening in Google Scholar, from database inception to the final search date. Due to the rarity of the phenomenon, a highly sensitive strategy using free-text terms will be used, including: “bladder explosion”, “intravesical explosion”, “vesical explosion”, and “estallido vesical”.
Data extraction and analysis
Data extraction will be performed using a standardized Microsoft Excel table to collect study characteristics, patient data, procedural details, intraoperative variables, management, and clinical outcomes. A descriptive analysis will be conducted.
Variables and Data Items Collected
Study characteristics: Author and year of publication
Patient characteristics: Patient age, Sex
Procedural performed: TURP, TURBT
Preexisting bladder conditions: Tumor, Post-radiotherapy changes, Bladder diverticulum, Bleeding, Bladder stone
Anesthesia: General, Spinal, Epidural, Not reported
Energy source: Monopolar, Bipolar
Electrosurgical parameters: Cutting power, Coagulation power
Irrigation solution: Glycine, Sterile water, Normal saline, Mannitol, Dextrose, Not reported
Irrigation flow: Intermittent, Continuous, Not reported
Intraoperative characteristics: Procedure duration until explosion, Visible gas bubble (Yes / Not reported)
Signs of bladder explosion: Pop sound, Jolt, Pain, Hypotension
Surgical moment: Resection, Hemostasis, Not reported
Immediate suspicion: Yes / No
Diagnostic method: Intraoperative (direct visualization), Imaging, Both
Bladder rupture: Yes / No
Location of injury: Dome, Anterior wall, Posterior wall, Lateral wall, Base, Not specified
Type of rupture: Intraperitoneal, Extraperitoneal
Bladder injury classification (adapted from AAST): Mild subclinical injury, Extraperitoneal rupture, Intraperitoneal rupture
Management: Conservative, Laparotomy, Laparoscopy
Bladder repair: Layered suture, Debridement, Reinforcement, Not specified
Surgical drains: Foley catheter, Suprapubic cystostomy, Abdominal drain, Double-J ureteral stent, Not specified
Conservative management measures: Foley catheter, Antibiotic therapy, Not reported
Outcomes: Recovery, Death
Complications: Respiratory failure, Post-TURP syndrome, Hemodynamic instability, Infection, Bladder dehiscence
Ethics and Dissemination
This study is based exclusively on previously published literature and does not involve identifiable patient data or direct intervention with human subjects; therefore, ethics committee approval was not required. The present protocol is adapted from a protocol previously developed and registered by the same authors in the Open Science Framework (OSF) (https://osf.io/q57m2), which is currently under embargo and will be made publicly available upon publication. The results will be disseminated through publication in a peer-reviewed scientific journal and through registration of the protocol on Protocols.io.