Transurethral resection of the prostate (TURP) is a common procedure for managing benign prostatic hyperplasia (BPH), and this procedure is associated with low complication rates. Bladder perforation is an unusual complication of TURP, and it may create an air leak into the retroperitoneal space. Here we describe a case of pneumomediastinum, pneumoretroperitoneum and subcutaneous emphysema that were all due to a bladder perforation that occurred during performing TURP in a 74-year-old male patient with BPH.