DATE OF OPERATION: MM/DD/YYYY
PREOPERATIVE DIAGNOSIS:
Hematuria and bladder lesion.
POSTOPERATIVE DIAGNOSES:
1. Multifocal bladder tumors of large and various sizes, greater than 5 cm on the right and down in the anterior bladder wall greater than 4 cm, posterior wall greater than 2 cm, and left bladder wall greater than 2 cm.
2. Bladder neck obstruction.
OPERATION PERFORMED:
TURBT using traditional resection and holmium laser.
SURGEON: John Doe, MD
ANESTHESIA: General LMA.
DESCRIPTION OF OPERATION: After the patient was brought to the surgical suite, placed on the surgical table in supine position, the patient was given general LMA anesthesia. After appropriate level was achieved, the patient was then placed in dorsal lithotomy position, prepped with Betadine and draped in aseptic fashion. Xylocaine 2% was infused into the urethra.
Then, the cystoscope was introduced into the bladder. Photos of the bladder tumors were captured and documented in the record. The bladder neck was also shown to have obstruction in the prostatic fossa secondary to elevated bladder neck. The bladder showed greater than 3+ trabeculation. After this was determined, the scope was used in order to remove the tumors of the left lateral wall, posterior wall, some to the dome and also the massive lesion to the right lateral wall where most of the tumor was concentrated with a large amount of flat tumors, which was greater than 10 cm in diameter. Once this was resected, we then switched out with the holmium in order to ablate the smaller tumors to maintain the bladder wall integrity.
After this was completed, the tumor was milked out appropriately. Retrograde was not performed because of the amount of tumor present in the bladder; however, the orifices were visible. Retrogrades would need to be done at a later date. After this, a 24-French catheter was placed into the bladder. It was irrigated to clear and 10 mL was placed in the balloon. The bimanual exam was done rectally, but there were no palpable masses. The patient was then extubated, awoken, and carried to recovery room in stable condition.
The patient will be admitted to 23 hours stay for hematuria and for pain management. The patient will have his Foley removed in the morning. After discharge, the patient will follow up in the office in approximately a week so that we may start him on BCG therapy for six weeks and then three months subsequently to try to spare his bladder. We will need to take a second look at the retrograde once we have stabilized this bladder floor.
