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Bladder Perforation During TURBT — FRCA Final MCQ

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ModerateGeneral AnaesthesiaBladder Perforation During TURBTFRCA Final

A 55-year-old man (ASA II) is having a transurethral resection of a bladder tumour (TURBT) under spinal anaesthesia. During resection of a lateral wall tumour, the patient suddenly reports severe shoulder pain. What is the most likely cause?

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Correct answer: E — Bladder perforation with peritoneal irritation of the diaphragm

Sudden shoulder tip pain during TURBT suggests bladder perforation with extravasation of irrigating fluid into the peritoneal cavity, causing diaphragmatic irritation (phrenic nerve, C3-C5 → shoulder tip referred pain). This is an advantage of performing TURBT under spinal rather than general anaesthesia – the conscious patient reports the pain, alerting the surgeon to perforation immediately. Management: stop resuscitation, insert urinary catheter on free drainage, CT to assess perforation, and surgical repair if extraperitoneal or large intraperitoneal perforation.

Reference: RCOA – 2023 – Urological anaesthesia module; BAUS – 2019 – TURBT guidelines