Krane TURBT Dictation

Preoperative diagnosis:

1. >1cm papillary bladder tumor

 

Postoperative diagnosis: Same

 

Procedures:

1. Transurethral resection of bladder tumor, tumor 0.5-2cm
2. Van Buren urethral meatus dilation
3. Foley catheter placement by MD
4. Intravesical instillation of gemcitabine

 

Surgeon: Louis Krane, MD

 

Assistants:

1. Brendan King, MD
2. Nick Ottaiano, MD

 

Anesthesia: General

 

Findings:

1. 1-2cm papillary bladder tumor on anterior bladder wall, tumor resected and sent to pathology for permanent section, no evidence of perforation or excessive bleeding
2. Short, wide caliber bulbar urethral stricture

 

Estimated blood loss: minimal

 

Implants: none

 

Drains: 16Fr foley catheter

 

Specimens:

1. Bladder tumor

 

Indications: The patient is an 86-year‐old male with a >1cm bladder tumor presenting for transurethral resection.

 

Description of Procedure: The indications, alternatives, benefits, and risks were

discussed with the patient and informed consent was obtained.

The patient was brought onto the operating room table, positioned supine, and secured

with a safety strap. Pneumatic compression devices were placed on the lower extremities.

After the administration of intravenous antibiotics and general anesthesia,

the patient was repositioned in dorsal lithotomy using universal stirrups and all

pressure points were carefully padded.  The genitalia were prepped and draped in the standard sterile manner.

A time‐out was completed, verifying the correct patient, surgical procedure, and

positioning, prior to beginning the procedure. Isotonic sodium chloride was used for irrigation.

 

We began by performing sequential Van Buren dilation of the urethral meatus from 18 to 28Fr. A 26 Fr continuous flow resectoscope sheath with a visual obturator and a 30 degree lens

was then advanced under direct vision into the bladder. The urethra appeared normal in its

entirety. On cystoscopic evaluation, the media was clear, the

bladder capacity was normal, and the bladder wall was noted to expand symmetrically

in all dimensions. There were no stones, foreign bodies, or diverticula present. The

bladder wall was moderately trabeculated. Both ureteral orifices were in the normal anatomic position with clear urinary efflux noted bilaterally. A 1-2cm bladder tumor was seen on the anterior wall near the bladder dome. The remaining mucosa appeared normal under blue light.

The obturator was removed and replaced by the working element with a resection

electrode loop. The location of the ureteral orifices was again confirmed.

The tumor was visualized and thoroughly resected to the detrusor muscle

incorporating muscularis propria, using a bipolar power setting of 200 and 120

watts for cutting and coagulation, respectively. Meticulous hemostasis was achieved.

The bladder was gently irrigated with an Ellik evacuator ensuring removal of all resected

tissue, and the specimen sent to pathology for evaluation. The bladder was again

visualized, confirming complete tumor resection, absence of bleeding or perforation,

and intact ureteral orifices.

 

The resectoscope was withdrawn under direct vision and a 16Fr urethral catheter was

inserted into the bladder and connected to a drainage bag. The irrigant was clear pink‑tinged. The patient was repositioned supine. 2g of gemcitabine diluted in 100cc normal saline was then instilled into the bladder with a planned dwell time of 1 hour.

 

At the end of the procedure, all counts were correct. The patient tolerated the procedure well and was taken to the recovery room in

satisfactory condition.

 

Disposition: Gemcitabine will be drained from the bladder and the catheter removed in 1 hour. Patient will then be scheduled for a follow up appointment in 2 weeks to review pathology.

 

Attending Attestation: Dr. Louis Krane was present and active for the duration of the procedure.