Transurethral resection of lesions in dome of bladder

TRANSURETHRAL

RESECTION

OF LESIONS

IN DOME OF BLADDER

DANIEL EDDIE

A. NACHTSHEIM,

M.D.

P. H. SO, M.D.

LAURENCE

F. GREENE,

M.D.,

PH.D.

From the Department of Surgery, Division of Urology, University California Medical Center, San Diego, and Urology Section, San Diego Veterans Administration Hospital, La Jolla, California

Transurethral resection of lesions located in the dome of the bladder or in the anterior vesical neck area can be a vexing problem for the resectionist. Maneuvers that may aid the surgeon in reaching this area with the resectoscope include maintenance of a small volume of irrigant in the bladder and exertion of suprapubic pressure over the bladder by the resectionist or an assistant. The use of a right-angle telescopic lens and occasionally bending the cutting loop may be helpful. In addition, turning the patient to the prone position may place the lesion in an easily accessible position, providing an improved mechanical advantage for resection. The prone position offers other advantages as well. Bubbles of gas, which may form and obscure lesions in the dome of the bladder

FIGURE 1. Patient standard

84

operating

FIGURE 2. Special prone position.

table for

of

use

with patient

in

when the patient is supine, present no problem when the patient is in the prone position. The prone position facilitates complete excision of lesions in this area and makes perforation of the bladder less likely. In women, resection of such lesions can be performed transurethrally; in men, however, perineal urethrostomy (performed before turning the patient to the prone position) is generally required to gain the proper angle for insertion of the resectoscope (Fig. 1). The use of a special table (Fig. 2), if available, is helpful but not essential. This allows the surgeon to sit between the outstretched legs of the prone patient. If a standard operating room table is utilized, much the same advantage may be attained by placing the patient prone and adjusting the table to place the patient in a semi-jackknife position (Fig. 1). University

in semi-jackknife position on table with resectoscope in place.

UROLOGY

of California Medical Center San Diego, California 92103 (DR. NACHTSHEIM)

/ JULY 1981 / VOLUME

XVIII, NUMBER

1