Bladder trauma can occur due to external reasons or internal ones like done by your doctor during performing cystoscopical procedures. If you are doing some procedures by cystoscope sometimes but very rarely perforation can occur. The fluid which is used to fill the bladder will start leaking in the abdominal cavity leading to ascites, abdominal distension, pain, electrolytes disturbances as that of raised urea, sodium, potassium etc. Breathless can also occur due to diaphragm getting pushed due to ascites.
In order to manage such situation, just remove cystoscope out, put a foley’s catheter so as to keep the bladder shrunken. Put a drain in abdomen so that if extravasation or urine occurs it can drain out of body. Check out the Arterial Blood Gas analysis every 3 hourly, keep patient in supine position, propped up. The perforation will heal itself in 7-8 days. Antibiotics like tazobactum & sulbactum to be used, give anticholinergics to prevent bladder spasms, manage pain. Remember irrigation should not be done.
Surgical management includes open the abdomen through midline incision, inspect the viscera, if pelvic hematoma is present leave it undisturbed, close the bladder injury in watertight fashion using 3 layers of absorable sutures.
Complications: complications of surgical correction of bladder perforation are small capacity bladder, de novo urge incontinence, pelvic infections, urinary extravasation.