Transurethral Resection of Bladder Tumour: Difference between revisions

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 [[Category:Bladder Cancer]]
+== Equipment ==
+=== Lens ===
+* The most common lenses used during a typical rigid cystourethroscopy are the 30° and 70° lens.
+*The urethra is best visualized using the 0 to 12° lens.
+*'''<span style="color:#ff0000">A thorough visual inspection at the time of TURBT involves using</span>'''
+**'''<span style="color:#ff0000">30° lens to examine the urethra and then to perform a preliminary evaluation of the bladder mucosa and ureteral orifices.</span>'''
+**'''<span style="color:#ff0000">70° lens should then be used to completely evaluate the bladder again with particular attention to the bladder neck, dome, and anterior wall.</span>'''
+***The 70° or 120° lens are often required to inspect the anterior and inferolateral walls, dome, and neck of the bladder.
+* '''<span style="color:#ff0000">For therapeutic purposes, a 30° lens is most often used</span>'''
+** Resection is performed using a 12- or 30° lens because this deflection allows visualization of the cutting loop.
+=== Monopolar vs. Bipolar ===
+* '''Advantages of bipolar (compared to monopolar)'''
+# '''Reduced risk of triggering an obturator reflex''' for tumours overlying the lateral walls of the bladder.
+#'''Reduced risk of postoperative electrolyte abnormalities since bipolar uses 0.9% NS as irrigation'''
+##More relevant for TURP
+# '''[Reduced bleeding, increased resection time]'''
+=== Irrigation fluid ===
+* '''<span style="color:#ff0000">Monopolar TURBT</span>'''
+**'''<span style="color:#ff0000">Can be performed with 1.5% glycine or sterile water</span>'''
+***'''<span style="color:#ff0000">Cannot be done with saline solutions</span>'''
+****'''Saline conducts electricity and disperse energy from the monopolar cautery cutting loop'''
+***1.5% glycine is more expensive than sterile water, and there is no evidence of its benefit in TURBT
+*'''<span style="color:#ff0000">Bipolar TURBT</span>'''
+**'''<span style="color:#ff0000">Performed with saline</span>'''
 == Checklist for High-Quality Transurethral Resection of Bladder Tumor ==
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 *# Lower risk of bladder perforation during TURBT
 * Benefit on disease recurrence has not been established
-== Lens ==
-* The most common lenses used during a typical rigid cystourethroscopy are the 30° and 70° lens.
-*The urethra is best visualized using the 0 to 12° lens.
-*'''<span style="color:#ff0000">A thorough visual inspection at the time of TURBT involves using</span>'''
-**'''<span style="color:#ff0000">30° lens to examine the urethra and then to perform a preliminary evaluation of the bladder mucosa and ureteral orifices.</span>'''
-**'''<span style="color:#ff0000">70° lens should then be used to completely evaluate the bladder again with particular attention to the bladder neck, dome, and anterior wall.</span>'''
-***The 70° or 120° lens are often required to inspect the anterior and inferolateral walls, dome, and neck of the bladder.
-* '''<span style="color:#ff0000">For therapeutic purposes, a 30° lens is most often used</span>'''
-** Resection is performed using a 12- or 30° lens because this deflection allows visualization of the cutting loop.
-== Irrigation fluid ==
-* '''<span style="color:#ff0000">Monopolar TURBT</span>'''
-**'''<span style="color:#ff0000">Can be performed with 1.5% glycine or sterile water</span>'''
-***'''<span style="color:#ff0000">Cannot be done with saline solutions</span>'''
-****'''Saline conducts electricity and disperse energy from the monopolar cautery cutting loop'''
-***1.5% glycine is more expensive than sterile water, and there is no evidence of its benefit in TURBT
-*'''<span style="color:#ff0000">Bipolar TURBT</span>'''
-**'''<span style="color:#ff0000">Performed with saline</span>'''
 == Obturator nerve reflex ==
@@ Line 97: / Line 106: @@
 *# '''Direct injection of local anesthetic (20-30 mL lidocaine) into the obturator nerve and its canal'''
 *# '''Tapping the peddle during resection'''
-== Advantages of bipolar TURP (compared to monopolar) ==
-# '''Reduced risk of postoperative electrolyte abnormalities since bipolar uses 0.9% NS as irrigation'''
-# '''Reduced risk of triggering an obturator reflex''' for tumours overlying the lateral walls of the bladder.
-# '''[Reduced bleeding, increased resection time]'''
 == Resection ==