Cystoscopy and TURBT

PREOPERATIVE DIAGNOSIS:  Bladder tumor.

POSTOPERATIVE DIAGNOSIS:  Bladder tumor.

PROCEDURE:  Cystoscopy and TURBT.

ANESTHESIA:  General.

INDICATIONS:  The patient is a 93-year-old man found to have gross painless hematuria.  The patient was found to have a large bladder tumor and recommended TURBT.  Risks and possible complications were discussed with him in detail.  He understood and agreed to proceed.

FINDINGS:  Normal penile urethra, prostatic urethra with trilobar hypertrophy, and visual obstruction.  The patient had a very large bladder tumor located on the trigone just posterior to the median lobe.  The remainder of the bladder was normal.

PROCEDURE IN DETAIL:  The patient was taken to the operating room.  He was given 500 mg of IV Levaquin.  He was given a general anesthetic by LMA and positioned on the operating table in the dorsal lithotomy.  His genitalia are prepped and draped in the usual sterile fashion.  The 22-French cystourethroscope was placed through the urethra into the bladder.  The bladder was thoroughly examined and findings as noted above.  Subsequently, the 27-Fernch resectoscope sheath was placed and the tumor was resected.  The tumor was resected down to the bladder muscle.  It became apparent that the tumor was invading deep into the bladder, and the resection was stopped when it was felt that we would never be able to completely resect this tumor.  Specimens were irrigated out of the bladder.  The bases of the tumor were then cauterized with electrocautery.  Adequate hemostasis had been achieved.  A 20-French Foley catheter was placed in the bladder and left indwelling.  The patient was awakened and taken to the recovery room in stable condition.  There were no complications.  Estimated blood loss was minimal.