Transurethral Resection of Bladder Tumour: Difference between revisions
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== Bimanual Examination Under Anesthesia Prior to Resection == | == Bimanual Examination Under Anesthesia Prior to Resection == | ||
=== '''Staging Based on Bimanual Examination''' === | |||
* EAU Guidelines | |||
** '''cT2a: nonpalpable''' | |||
** '''cT2b: induration but no 3D mass''' | |||
** '''cT3: 3D mass that is mobile''' | |||
** '''cT4a: invading adjacent structures such as the prostate, vagina, or rectum''' | |||
** '''cT4b: fixed to pelvic sidewall and not mobile''' | |||
=== Technique === | |||
* '''Bimanual examination of the bladder with the patient under anesthesia is done before preparation and draping (unless the tumor is clearly small and noninvasive), and repeated after resection''' | * '''Bimanual examination of the bladder with the patient under anesthesia is done before preparation and draping (unless the tumor is clearly small and noninvasive), and repeated after resection''' | ||
* The dominant hand is placed on the suprapubic region and one or two fingers from the nondominant hand in the rectum (males) or vagina (females). | * The dominant hand is placed on the suprapubic region and one or two fingers from the nondominant hand in the rectum (males) or vagina (females). | ||
* Fixation or persistence of a palpable mass after resection suggests locally advanced disease | * Fixation or persistence of a palpable mass after resection suggests locally advanced disease | ||
=== Indications === | |||
* The additional value of this maneuver in the era of modern imaging appears limited and may even be misleading | * The additional value of this maneuver in the era of modern imaging appears limited and may even be misleading | ||
** 11% clinical overstaging and a 31% clinical understaging rate | ** 11% clinical overstaging and a 31% clinical understaging rate | ||
==== AUA ==== | |||
* '''2016 AUA NMIBC guidelines: can assist with clinical staging''' | |||
==== CUA ==== | |||
* '''2021 CUA NMIBC guidelines: included in checklist of high-quality TURBT (see above)''' | |||
*2015 CUA NMIBC guidelines: a valuable staging component of the TURBT procedure (Level of Evidence 3) | |||
* | |||
== Resection == | == Resection == | ||
* '''See [https://pubmed.ncbi.nlm.nih.gov/21156035/ BJUI Surgical Atlas] for details and figures''' | * '''See [https://pubmed.ncbi.nlm.nih.gov/21156035/ BJUI Surgical Atlas] for details and figures''' | ||
*See [https://www.youtube.com/watch?v=FixJhTX3Fy0 Video] (Dr. Divakar Dalela) | |||
*See [https://www.youtube.com/watch?v=Vl4Ojb_2dVk Video] (Dr. Brojen Barman) | |||
*'''2016 AUA NMIBC Guidelines: During resection, tumors of significant size should be resected and labeled''' | *'''2016 AUA NMIBC Guidelines: During resection, tumors of significant size should be resected and labeled''' | ||
*'''2015 CUA NMIBC Guidelines: Complete resection of all visible tumours with adequate depth to include muscularis propria should be performed, when feasible''' | *'''2015 CUA NMIBC Guidelines: Complete resection of all visible tumours with adequate depth to include muscularis propria should be performed, when feasible''' | ||
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*** '''Increased pressure of irrigation fluid''' | *** '''Increased pressure of irrigation fluid''' | ||
***'''With TURP: large glands >45g''' | ***'''With TURP: large glands >45g''' | ||
* <span style="color:#ff0000">Sepsis | * <span style="color:#ff0000">'''Sepsis''' | ||
* <span style="color:#ff0000">Foot drop (common peroneal nerve) | * <span style="color:#ff0000">'''Foot drop (common peroneal nerve)''' | ||
=== Late post-operative === | === Late post-operative === | ||