# A Case of Intraoperative Bladder Rupture During Kidney Transplantation

## TL;DR

A rare case of bladder rupture during kidney transplant surgery is reported, highlighting the importance of careful catheter handling in patients with low-compliance bladders.

## Contribution

This case report adds to the understanding of intraoperative bladder rupture risks during kidney transplantation in patients with bladder atrophy.

## Key findings

- Bladder rupture occurred during saline injection in a patient with a low-compliance bladder.
- The rupture was repaired with full-thickness sutures and surgical approach was modified.
- Voiding improved without complications after catheter removal on postoperative day 21.

## Abstract

Bladder rupture is a rare complication of kidney transplantation, with an increased risk in patients with low‐compliance bladders.

A man in his 40s with end‐stage renal disease secondary to diabetic nephropathy underwent ABO‐incompatible living‐donor kidney transplantation. He had been anuric for 3.5 years. Bladder rupture was identified during saline injection into the bladder before ureterovesical anastomosis was performed. It was repaired using full‐thickness sutures, and the surgical approach was changed from ureterovesical anastomosis to ureteroureterostomy. The catheter was removed on POD 21, and voiding improved over time without complications.

In patients with bladder atrophy, preventing sudden increases in intravesical pressure and ensuring careful catheter handling are crucial for avoiding bladder rupture.